Rural Hospital Closures and Local Economic Decline

Vogler, Jacob

doi:10.2139/ssrn.3750200

Cited by 7 publications

(16 citation statements)

References 9 publications

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“…Two recent working papers, each focusing on distinct sets of county-level economic outcomes, find contrasting evidence around these questions. 14,15 In this national study, we deploy robust new difference-indifferences analytic methods to examine the evolution of county-level economic outcomes before and after rural hospital closures from 2005 to 2018. Specifically, we estimated changes in a broad set of economic indicators -area-level per capita income, employment opportunities, measures of household financial security, and population -in counties that experienced rural hospital closures compared to those that did not over the same period.…”

Section: Introductionmentioning

confidence: 99%

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Changes in economic outcomes before and after rural hospital closures in the United States: A difference‐in‐differences study

Chatterjee

Lin

Venkataramani

2022

Health Services Research

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Objective The objective of this study is to assess changes in local economic outcomes before and after rural hospital closures. Data Sources Rural hospital closures from January 1, 2005, to December 31, 2018, were obtained from the Sheps Center for Health Services Research. Economic outcomes from this same period were obtained from the Bureau of Labor Statistics, Bureau of Economic Analysis, Quarterly Workforce Indicators, U.S. Federal Reserve Economic Data, RAND Corporation state statistics database, U.S. Social Security Administration, and U.S. Census Bureau. Design Difference‐in‐differences study of 2094 rural counties. Data Collection/Extraction The primary exposure was county‐level rural hospital closures. The primary outcomes were county‐level unemployment rates; employment‐population ratios; labor force participation‐population ratios; per capita income; total jobs; health care sector jobs; disability program participation‐population ratios; percent of the population with subprime credit scores; total filings for bankruptcies per 1000 population; and population size. Principal Findings A total of 104 rural counties experienced a hospital closure, compared to 1990 rural counties that did not. Rural hospital closures were associated with significant reductions in health care sector employment (−13.8%; 95% CI: −22%, −5.6%; p < 0.001), but not with changes in any other economic measure. For unemployment rates, employment‐population ratios, per capita income, disability program participation‐population ratios, and total jobs, we found evidence of adverse trends preceding hospital closures. Findings were robust to adjusting for county‐specific time trends, specifying exposure at the commuting zone‐level, and using alternate definitions of rurality to define sample counties. Conclusion With the exception of a decline in jobs within the health care sector, there was no association between rural hospital closures and county‐level economic outcomes. Instead, economic conditions were already declining in counties experiencing closures compared to those that did not.

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Section: Introductionmentioning

confidence: 99%

“…In this way, rural hospital closures may be a symptom of economic decline, as well as a potential driver. Two recent working papers, each focusing on distinct sets of county‐level economic outcomes, find contrasting evidence around these questions 14,15 …”

Section: Introductionmentioning

confidence: 99%

Changes in economic outcomes before and after rural hospital closures in the United States: A difference‐in‐differences study

Chatterjee

Lin

Venkataramani

2022

Health Services Research

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“…24,25 Vogler and Malone et al estimate decreases in labor force participation after hospital closure, suggesting a mechanism behind the decrease in employment. 26,27 Importantly, much of the recent work has found evidence of economic decline before hospital closure, suggesting that local economic conditions may be contributing to rural hospital strain.…”

Section: Access To Care: Hospital and Service Line Closuresmentioning

confidence: 99%

“…Alexander and Richards, and in this issue, Chatterjee et al find that health care employment decreases after hospital closure but find few effects on the economy outside of the health care sector 24,25 . Vogler and Malone et al estimate decreases in labor force participation after hospital closure, suggesting a mechanism behind the decrease in employment 26,27 . Importantly, much of the recent work has found evidence of economic decline before hospital closure, suggesting that local economic conditions may be contributing to rural hospital strain.…”

Section: Access To Care: Hospital and Service Line Closuresmentioning

confidence: 99%

Reimagining and reinvesting in rural hospital markets

Carroll

Planey²,

Kozhimannil

2022

Health Services Research

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“…15 The results for effects on employment outcomes are also mixed. Two studies using Quarterly Census of Employment and Wages (QCEW) data found that rural hospital closure was associated with significant reductions in total employment (2.9%-4.3%) 16,17 whereas a recent study using Quarterly Workforce Indicators (QWI) data found no effect on total employment. 18 Two of these studies also found that rural hospital closure was associated with significant reduction in health sector employment (10.6%-13.8%).…”

Section: Introductionmentioning

confidence: 99%

The effect of nursing home closure on local employment in the United States

Sharma

Wehby

2023

Health Services Research

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Objective To estimate the effect of nursing home closure on local employment, overall, and by rurality. Data Sources and Study Setting We obtained 2008–2018 county‐level data from the Quarterly Workforce Indicators, Medicare Provider of Services, Area Health Resource, and Urban Influence Codes files. From 2008 to 2018, 878 counties experienced at least one nursing home closure, and 2055 counties did not experience a closure. Study Design Using a difference‐in‐difference study design, we compare the changes of total employment, health sector employment and non‐health sector employment over time between counties with and without a nursing home closure. We utilize the variation in the year and quarter of nursing home closures to estimate subsequent employment changes as well as employment trends before closure. We also account for contemporaneous events including nursing home entries and hospital entries and closures, and evaluate heterogeneity by rurality. Data Extraction We include data on nursing home closure from the Medicare Provider of Service file. Quarterly county‐level employee counts were obtained from the Quarterly Workforce Indicators provided by the Census Bureau. County‐level demographic data were obtained from the Area Health Resource Files. We use Urban Influence Codes from the Economic Research Service, Department of Agriculture, to classify metropolitan, micropolitan, and rural (noncore) counties. Principal Findings Health sector employment decreased by about 3.2%–4.1% (p < 0.01) in counties with a nursing home closure. The reduction was largest in rural counties (approximately 7.2%–9.4%, p < 0.01). The reduction in health sector employment persisted over time, particularly in rural counties. Overall, there was no discernable effect on non‐health sector employment. Conclusions Nursing home closure is associated with a persistent decline in health sector employment, particularly in rural counties, suggesting a reduction in the health care workforce and in the ability to sustain health care services supply, particularly in rural areas.

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Rural Hospital Closures and Local Economic Decline

Cited by 7 publications

References 9 publications

Changes in economic outcomes before and after rural hospital closures in the United States: A difference‐in‐differences study

Changes in economic outcomes before and after rural hospital closures in the United States: A difference‐in‐differences study

Reimagining and reinvesting in rural hospital markets

The effect of nursing home closure on local employment in the United States

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