Changes in access to community health services among rural areas affected and unaffected by hospital closures between 2006 and 2018: A comparative interrupted time series study

Abstract

Purpose: Recent studies suggest that Federally Qualified Health Centers (FQHC) may be expanding their provision of primary care in rural communities that experience a hospital loss. Whether these trends are different from rural areas not being affected by rural hospital closures is unknown. Methods: Data included Centers for Medicare and Medicaid Services Provider of Services files, the Cecil G. Sheps hospital closure database, and American Community Survey estimates. Changes in straight-line distances to the nearest FQHC and rural health clinic (RHC) were compared between areas affected and unaffected by a rural hospital closure in a matched case control study design using an interrupted time series model.Findings: There was no instantaneous percentage point increase in FQHC (2.41, 95% CI −0.79 to 5.60, P .140) or RHC (3.27, 95% CI −1.12 to 7.67, P .144) access following hospital closures compared to changes in access occurring in other rural areas. On average, rural ZIP codes affected by hospital closures exhibited a 0.84 percentage point increase in FQHC access over time (95% CI 0.40-1.28, P .000), but similar trends were also found within unaffected ZIP codes classified as small rural areas.Conclusions: Rural areas impacted by hospital closures did not experience an increase in proximity to FQHCs or RHCs relative to changes in access occurring in other rural areas. Over time, most rural areas are seeing an increase in access to FQHCs and RHCs.Policies are needed to incentivize primary care providers to target geographic areas experiencing a hospital closure.

Understanding the impacts of rural hospital closures: A scoping review

“…28 However, another study assessing differences in growth of RHCs and FQHCs across all rural areas found that growth of these services was unchanged between communities that experienced closure and those that did not. 29 This finding suggests these centers are not being developed in a targeted fashion to mitigate challenges for communities experiencing rural hospital closure.…”

The impact of rural general hospital closures on communities—A systematic review of the literature

“…Overall, 89% of the studies that examined the economic outcomes of rural hospital closures found unfavorable outcomes, including decreased income, population, and community economic growth, and increased poverty. 13,24,[34][35][36][37][38][39][40] The most commonly studied outcomes were income and population, both of which decreased in five of six studies, 24,[36][37][38][39] although one study observed increases in both. 34 Population was included in this category as changes in the population following rural hospital closure would likely impact the local economy.…”

“…24,39 Other economic outcomes considered in more than one study include community economic growth, poverty, rent, and tax revenue, with all finding unfavorable results. 13,[36][37][38][39][40]…”

“…Employment and unemployment rates were found to have unfavorable outcomes by all seven studies, particularly if the closed hospital was the sole hospital in the community. 13,24,[36][37][38][39][40] Unemployment rates increased by 1.6%-3.1% following rural hospital closures. 24,38,39 In addition to decreases in health care employment, rural hospital closures were found to lead to unemployment spillover into non-health care sectors, as well, resulting in decreases in nonhospital employment, including information, scientific, construction, education, and real estate; and certain jobs, including management, natural resources, arts, and maintenance.…”

Structural Factors and Racial/Ethnic Inequities in Travel Times to Acute Care Hospitals in the Rural US South, 2007–2018

“…However, these estimates were based on travel distance between facilities rather than travel between populations and facilities. A recent study by Bell and colleagues found that distance to outpatient safety net providers, e.g., federally qualified health centers (FQHCs), from rural ZIP codes was unchanged after hospital closures; the authors proposed that federal support for FQHC expansion may have offset hospital changes 62 . A 2020 US Government Accountability Office report found that patients in areas previously served by a closed rural hospital had increased median travel distance to care, from 3.4 miles for general inpatient services in 2012 to 23.9 miles in 2018 (a 20.5‐mile increase in six years), with lower utilization of health services among Medicare beneficiaries 15 .…”