When Rural Hospitals Close, The Physician Workforce Goes

Germack, Hayley D.; Kandrack, Ryan; Martsolf, Grant R.

doi:10.1377/hlthaff.2019.00916

Cited by 65 publications

(76 citation statements)

References 27 publications

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“…Lack of access to both PCPs and specialists in rural areas may also reflect and be compounded by recent trends in availability of local inpatient hospital care, an important aspect of the management of chronic HF. Over the past decade, rural counties have experienced disproportionate rates of hospital closures, and in the six years following a hospital closure, rural counties experienced an 8.2% decrease in both PCPs and medical specialists [47]. Expansion of Medicaid coverage may be a viable health policy intervention to target HF-related mortality rates as rates of hospital closure have been lower in states that expanded Medicaid in part due to uninsured patients gaining Medicaid coverage, particularly in rural counties [48,49].…”

Section: Role Of Access To Care In Rural Counties In Hf-related Mortamentioning

confidence: 99%

Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011–2018: A cross-sectional study

et al. 2021

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Background Adults in rural counties in the United States (US) experience higher rates broadly of cardiovascular disease (CVD) compared with adults in urban counties. Mortality rates specifically due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality have not been produced. The objectives of this study were 1) to quantify nationwide trends by rural-urban designation and 2) examine county-level factors associated with rural-urban differences in HF-related mortality rates. Methods and findings We queried CDC WONDER to identify HF deaths between 2011–2018 defined as CVD (I00-78) as the underlying cause of death and HF (I50) as a contributing cause of death. First, we calculated national age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35–64 and 65–84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011–2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for demographic and socioeconomic characteristics, risk factor prevalence, and physician density. Between 2011–2018, 162,314 and 580,305 HF-related deaths occurred in rural and urban counties, respectively. AAMRs were consistently higher for residents in rural compared with urban counties (73.2 [95% CI: 72.2–74.2] vs. 57.2 [56.8–57.6] in 2018, respectively). The highest AAMR was observed in rural Black men (131.1 [123.3–138.9] in 2018) with greatest increases in HF-related mortality in those 35–64 years (+6.1%/year). The rural-urban IRR persisted among both younger (1.10 [1.04–1.16]) and older adults (1.04 [1.02–1.07]) after adjustment for county-level factors. Main limitations included lack of individual-level data and county dropout due to low event rates (<20). Conclusions Differences in county-level factors may account for a significant amount of the observed variation in HF-related mortality between rural and urban counties. Efforts to reduce the rural-urban disparity in HF-related mortality rates will likely require diverse public health and clinical interventions targeting the underlying causes of this disparity.

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Section: Role Of Access To Care In Rural Counties In Hf-related Mortamentioning

confidence: 99%

Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011–2018: A cross-sectional study

et al. 2021

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“…Considering this, we completed a post-hoc analysis to consider rural closure trends, which provide a clearer narrative. 9 While rural closures were less likely to occur when looking at the studied time period as a whole due to fewer occurrences as compared to non-rural communities in the early years of the study, we can see a clear trend in rural hospital closures increasing over time. For example, in 2010, .1% of rural hospitals closed, compared to .2% of nonrural; in 2016, .8% of rural hospitals closed, compared to .3% of nonrural (see Fig.…”

Section: Discussionmentioning

confidence: 74%

“…8 Existing research suggests that when hospitals close, communities not only lose economic resources, but a consistent supply of health care professionals and services. 9 Hospital closures are more likely to negatively affect the long-term economic prospects of a community when that hospital is the sole hospital in a community, such as in rural areas of the U.S. In these cases, the economic impact can be pronounced-with a lasting decline in per capita income and rise in unemployment.…”

Section: Introductionmentioning

confidence: 99%

Closures and Other Anchor Characteristics of for-profit Hospitals: A Cross-sectional Study

Franz¹,

Cronin²,

Rodríguez³

et al. 2021

Preprint

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Background:By definition, anchor institutions have a long-term presence in their communities. Case studies of nonprofit anchor hospitals are common, but it is not clear whether for-profit hospitals are stable enough to fill this role. Our purpose is to determine whether for-profit hospitals are stable enough to fill the role of anchor institutions by strengthening their communities and elevating population health through a long-term presence stabilizing local economies. Methods: In this cross-sectional study, we analyzed national, secondary data between 2008 and 2017 compiled from the Dartmouth Atlas of Health Care, the American Hospital Association Annual Survey, and County Health Rankings. We used descriptive statistics to calculate the number of closures and mergers of hospitals of different ownership type, as well as the employment data. Using logistic regression, we assess whether for profit hospitals had higher odds of closing and merging, controlling for both organization and county characteristics.Results: For-profits are less stable than other hospitals, experiencing disproportionately more closures and mergers over time; a multivariate analysis found that this was a statistically significant difference. Additionally, for-profit hospitals have fewer full-time employees relative to their size than hospitals of other ownership types, as well as lower total payroll expenditures.Conclusions: Our findings suggest that for-profit hospitals are more efficient in terms of operating expenses, but this also may translate into a lower level of economic investment in the surrounding community. For-profit hospitals may also not have the stability required to serve as long-standing anchor institutions. Nonetheless, these organizations still have considerable potential due to their size, tax contributions, and impact on vulnerable communities where other types of hospitals have not been able to operate successfully. Identifying new policy incentives to engage these institutions may help improve population health in surrounding communities.

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“…Compared to urban populations, rural residents tend to be older, have more comorbidities and higher rates of high risk behaviors, lower income, and are often uninsured or underinsured 28 , 29 , 30 . Counties with a higher proportion of rural residents tend to have fewer primary care providers and surgeons 30 , 31 . and have long suffered after the closure of over 120 rural hospitals over the last decade 32 .…”

Section: Introductionmentioning

confidence: 99%

Health care disparities during the COVID-19 pandemic

Andraska

Alabi

Dorsey

et al. 2021

Seminars in Vascular Surgery

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COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), has caused an international pandemic, with over 32 million cases and more than 500,000 deaths nationwide. With the significant health consequences seen secondary to COVID-19, healthcare disparities have been further exacerbated. Mechanisms that have been proposed to account for the increased disparity seen during the COVID-19 pandemic are multifactorial. This review of the literature outlines the unique barriers to health and disparities which are associated with vulnerable communities who have been most impacted by the COVID-19 pandemic in the United States.

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When Rural Hospitals Close, The Physician Workforce Goes

Cited by 65 publications

References 27 publications

Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011–2018: A cross-sectional study

Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011–2018: A cross-sectional study

Closures and Other Anchor Characteristics of for-profit Hospitals: A Cross-sectional Study

Health care disparities during the COVID-19 pandemic

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