Many Rural Americans Face Long Haul to Access Care

A GAO report paints a bleak picture of the state of healthcare access in rural America.

More than 100 rural hospitals in the United States closed between 2013 and 2020 and that has significantly increased the travel distance to access care for Americans living in those shuttered service areas, according to a Government Accountability Office report.  

"Specifically, for residents living in these service areas, GAO's analysis shows that the median distance to access some of the more common healthcare services increased about 20 miles from 2012 to 2018," according to the report, Rural Hospital Closures: Affected Residents Had Reduced Access to Health Care Services, which was made public this month.

It's even worse for rural patients seeking specialized care.

"For example, among residents in the service areas of the 11 closed hospitals that offered treatment services for alcohol or drug abuse, the median distance was 5.5 miles in 2012, compared to 44.6 miles in 2018—an increase of 39.1 miles to access these services," GAO said.

There were more than 2,200 rural hospitals representing 48% of the nation's hospitals in 2017, providing care in 84% of the U.S. land area, and serving 18% of the U.S. population. Numerous studies have shown that rural patients tend to be older, sicker, poorer and more likely to rely on Medicaid and Medicare.

The closures also had a deep economic effect on the immediate areas they serve, because hospitals are often the largest employers in a region.

Federal data show that rural communities have lost 2,066 inpatient beds and 6,347 full-time employees because of rural hospital closures from 2013 through 2017.

Making matters worse for residents in closed service areas was the exodus of physicians when hospitals closed, further hindering access to care, GAO said.

"Specifically, counties with closures generally had fewer healthcare professionals per 100,000 residents in 2012 than did counties without closures," GAO said.

Between 2012 and 2017, "the availability of physicians declined more among counties with closures—dropping from a median of 71.2 to 59.7 per 100,000 residents—compared to counties without closures—which dropped from 87.5 to 86.3 per 100,000 residents," GAO said.

In the year before shuttering, hospitals that closed between 2014 and 2017 had a median of 30 inpatient beds and 96 full-time-employees. By comparison, open rural hospitals in 2017 had a median of 25 inpatient beds and 179 full-time-employees.

Stressors Grow

GAO said an analysis of data from the Department of Health and Human Services showed that many of the closed hospitals were in financial distress or operating in the red years before they shuttered.

"Specifically, for hospitals that closed from 2014 through 2017, the median margin declined from -3.3% in 2012 (the year prior to our closure study period) to -13.8% in the year prior to closure—a reduction of 10.5 percentage points," GAO said.

The study cited research from the North Carolina Rural Health Research Program which found that many hospitals that are still open are in financial peril.

"Consistent with our findings, NC RHRP's research found that the margins for rural hospitals have declined from 2016 through 2018, putting these hospitals at higher risk of financial distress," GAO said.

"Moreover, the percentage of rural hospitals classified as high or mid-high risk of financial distress has increased over the past 5 years—from 24% in 2015 to 26.2% in 2019," GAO said, with a particularly large increase in financial distress for rural hospitals in the South, which also saw the highest numbers of hospital closures.

The GAO report was requested by U.S. Sen. Gary Peters, D-Mich., the new chairman of the Committee on Homeland Security and Governmental Affairs.