Dear Mr. Dodaro:
I am writing to request that the Government Accountability Office (GAO) conduct a study into the impact of rural hospital closures on communities across the United States.
Rural hospitals are a critical part of the fabric of communities across the country. In Michigan, 1 in 4 residents live in a rural area, where the most comprehensive and sometimes only source of health care is at the local hospital. These facilities give annual check-ups, set broken bones, respond to overdoses, and provide a vast array of badly needed care to millions of individuals and families. Seven of the nation’s top 100 critical access hospitals, which are located in rural areas, are currently in Michigan.
Rural hospitals are also key economic drivers in their communities. Rural hospitals provide jobs, employing doctors, nurses, social workers, and other staff, and they purchase goods and services, contributing to local businesses. According to the National Rural Health Association, each critical access hospital invests an average of $7.1 million in the surrounding community every year in wages, salaries, and benefits from hospital operations.
In recent years, rural hospitals have been closing at an increasing rate. In an August 2018 report, GAO found that 64 rural hospitals closed from 2013-2017, over double the number of closures in the preceding 5-year period. These closures can have devastating effects on individuals and communities. When hospitals close, residents must travel further for medical treatment, and many may not be able to make the trip. Closures are associated with providers leaving the area and gaps in access to primary and specialty care. In Michigan, over 25% of rural hospitals are at high financial risk of closing, according to a recent analysis.
To better understand the impact of rural hospital closures on local residents and communities, and as a continuation of GAO’s work on this issue, please address the following questions:
1. How many rural hospitals have closed in the past six years? Please provide the number and location of closures for each year from 2013 through the most recent year available.
2. What has been the impact of rural hospital closures on residents of rural areas, and which residents have been most impacted by these closures?
3. How have rural hospital closures affected rural residents’ access to needed health care services, including inpatient and outpatient care? Please include information on access to emergency room care, primary care, and behavioral health care, such as treatment for opioid addiction.
4. How many jobs have been lost due to rural hospital closures? In particular, how many people did rural hospitals employ, and how many full-time positions did they offer, in the years leading up to closure? Were there any patterns in rural hospital employment as hospitals neared closure?
5. What is known about the financial health of the remaining rural hospitals?
Thank you for your attention to this request.
Source: U.S. Senate Committee on Homeland Security and Governmental Affairs
