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Rural Health System Resources


Understanding the impacts of rural hospital closures: A scoping review


Mullens CL, Hernandez JA, Murthy J, Hendren S, Zahnd WE, Ibrahim AM, Scott JW.


Rural hospitals in the United States are closing at unprecedented rates, with hundreds more at risk of closure in the coming 2 years. Multiple federal policies are being developed and implemented without a salient understanding of the emerging literature evaluating rural hospital closures and its impacts. We conducted a scoping review to understand the impacts of rural hospital closure to inform ongoing policy debates and research.

Why is this useful for rural and remote people?

Having a rural hospital, or primary care clinic, has obvious benefits in terms of local health and wellbeing in rural and remote towns. However, health care and social assistance services also play other roles in the local economy of rural and remote towns as business investors and employers. In most rural and remote towns in Australia, health and social assistance is the latest or second largest employer in town. This produces flow-on benefits in terms of money coming into a rural and remote town in the form of health worker salaries to spend on housing and at local stores. There are also induced benefits - for example, the ability to attract local teachers, police or paramedics to work in a rural or remote town is often dependent on their ability to access local health care when they need it. The loss of local health services has a cascade impact on towns in terms of health care access and equity, local employment and economic activity, and the ability to attract and retain an essential service workforce. This in turn means that governments are forced to pay incentives to attract and retain essential workers, and fund social welfare and unemployment benefits, as well as dealing with the costs of increasing rates of chronic disease that result from lack of adequate access to primary health care in particular. It is argued by some that closing local hospitals and health services deliver cost savings to health departments that are better invested in centralised services in the cities, but these 'savings' re-appear as new costs for other parts of governments (e.g. reduction in access to health care shifts costs to the provision of incentives for teachers and police to work rurally; increased rates of chronic disease shifts costs from primary care (low cost) to deal with accelerating rates of avoidable hospitalisations (high cost); reductions in health employment shifts costs to social welfare for unemployment of staff that would have worked in the health system, and due to people dropping out of the workforce due to the growth in the rate of unemployment). It is important for rural and remote communities to demonstrate the local flow-on impact of the withdrawal of health and hospital care in rural and remote towns, and to identify how this leads to greater costs on other parts of government, in advocating for a fair distribution of health resources to rural and remote communities.

Suggested Citation

Mullens CL, Hernandez JA, Murthy J, Hendren S, Zahnd WE, Ibrahim AM, Scott JW. Understanding the impacts of rural hospital closures: A scoping review. J Rural Health. 2024 Mar;40(2):227-237. doi: 10.1111/jrh.12801. Epub 2023 Oct 11. PMID: 37822033.


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