Rural hospitals across the United States are facing an unprecedented rate of closures, further endangering the health of rural communities. According to a recent report by the Center for Health Care Quality and Payment Reform, 631 rural hospitals are currently at risk of closing in the immediate and near future. This equates to approximately 30% of all rural hospitals.
Although these closures affect all regions of the country, the hardest hit states are Connecticut, Alabama, Hawaii and Mississippi, where the percentages of rural hospitals at risk of closure are 67%, 60%, 75 % and 54%. , respectively.
A 2022 American Hospital Association (AHA) report says the main issues threatening rural hospitals are low reimbursement rates, staffing shortages, low patient volumes, ongoing financial challenges from the COVID-19 pandemic, and aging infrastructure. In addition, the report describes how expenditures on labour, drugs, supplies and equipment have increased dramatically over the past year, putting additional pressure on rural hospital finances.
This is not a new phenomenon. The AHA report says 136 rural hospitals closed from 2010 to 2021, with a record 19 closings in 2020 alone, the most of any year in the past decade.
Before the pandemic, hundreds of rural hospitals could barely keep their doors open. The COVID-19 pandemic has greatly exacerbated financial pressures, including due to the cancellation of scheduled procedures and care, creating an estimated 70% loss in revenue for rural hospitals.
The financial burden on rural hospitals is only increasing. Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research which oversees the North Carolina Rural Health Research Center, said many rural health professionals “are gravely concerned about what the rest of this year will look like. and… 2023.”
The effects of hospital closures on rural communities are many and far reaching. With a hospital closed, patients may be forced to travel for hours for emergency or regular medical care, which can lead to significant delays in treatment. These delays exacerbate existing health disparities faced by workers in rural areas who are more likely – due to poverty, limited access to primary care or reduced access to health insurance – to suffer from chronic diseases.
Healthcare workers are grappling with the conditions created by hospital closures and hospitals on the brink of financial collapse. World Socialist Website Journalists reached out to healthcare workers on social media about their working conditions in rural areas and the stress of increased hospital closures on the medical system.
An emergency doctor, who chose to remain anonymous, told WSWS reporters on Reddit that he had recently resigned from his rural job due to untenable conditions. “I didn’t feel good about providing shitty care in a collapsing health care system and I quit. I don’t know if I made the right choice, but I reached my breaking point.
“Staff were gutted during COVID, now volumes are back but they left the skeleton team to handle this. On a single doc site, I was constantly overwhelmed with volume and sharpness.
He continued: “To make matters worse, this critical access hospital has cut ICU beds and floor beds in half, meaning there was almost never room in the hostel. Normally that would just mean I would have to transfer more people, no problem. But today, there are no other hospitals to take these patients, so they languish with me.
He described the emotional difficulty of repeatedly seeing patients deteriorate for lack of better resources. “I couldn’t stand watching a [necrotizing fasciitis, a rare bacterial infection] patient deteriorates until he is under [vaso]pressers before I can make a tertiary center bite. The same goes for gastrointestinal bleeding, hand trauma, psychiatric disorders, etc. There was also no viable outpatient route to refer my patients to government insurance. Everything was so sad and stressful.
An EMS worker from rural Colorado described the particular challenges of EMS workers in areas with poor access to care, as well as the domino effect that long transfers can have on the entire health care system.
“Our closest regional ERs are 40 to 60 miles one way over mountain passes. He pulls an ambulance out of the district for a 3-6 hour round trip depending on weather or traffic to and from. Our closest STEMI/Stroke/Level I traumas are 60-85 miles from our district if we can’t catch a flight.
This worker also described how the additional lack of resources in his area due to the closures has created a situation where EMS has become the only health care option available to some workers.
“This leaves us taking over for people with chronic illnesses in the district who become frequent users of our service for lifting aids, emergency room visits when they get sick/treat infections because their illness doesn’t is not managed effectively and similar problems.”
An OB/GYN doctor, who also chose to remain anonymous, spoke to reporters about the impact of the COVID-19 pandemic on the already struggling rural health system in his area.
“COVID hit us hard, but about 6 months later than everyone else. We lost a ton of surgeries in 2020 which hurt the bottom line. We are still in the dark, but barely.
She went on to express concern that her hospital would shut down its labor and delivery unit, as neighboring hospitals have done. “Several other hospitals in the region are probably reducing their learning and treatment units, some due to the lack of doctors, others due to the lack of deliveries. We are still doing well there, but I am working hard to make sure of this by creating a midwifery service so that fewer doctors can cover.It will not help maternal morbidity/mortality if all rural county hospitals close their learning and development units.
The working class is the hardest hit by the rural health care crisis. The closure of a county hospital creates a worsening of unemployment, with hundreds of workers abruptly laid off. With the loss of nearby medical care, many workers in all industries are foregoing care altogether, with no time off or money for gas to make the hours-long journey to the nearest open hospital.
Rural communities are already struggling with other medical shortages. The AHA’s 2022 report indicated that 70% of primary care shortages were in rural areas. Additionally, 65% of rural counties in the United States do not have a psychiatrist, 47% do not have a psychologist, and 81% do not have a psychiatric nurse practitioner. The March of Dimes also recently published a report showing that one-third of US counties are “maternity care deserts,” a tragedy that is dramatically increasing infant and maternal mortality rates in both rural and urban areas.
Rural hospital closures are entirely the result of the capitalist market, which treats health care delivery as a profit-making enterprise rather than a social right. Many facilities, in rural and non-rural settings, have been bought out, merged or suffered cuts in services deemed insufficiently lucrative. The deterioration in Medicaid reimbursement rates accompanying the imposition of the Obama-era Affordable Care Act, which shifted millions of impoverished Medicaid beneficiaries into the private health insurance industry market, has fueled the pursuit of profit.
Emergency rooms and hospitals in rural and urban areas are in deep crisis, reeling from decades of budget cuts and austerity, compounded by the spread of COVID-19 variants, RSV, influenza and shortages unprecedented staff. At a time when rural health systems are needed more than ever, the increase in hospital closures only underscores the need for a socialist reorganization of health care.