The core issue addressed in this study is how residents of those communities continue to access healthcare services in the absence of inpatient acute care services through a local hospital. We hypothesize that use of services after losing acute inpatient care varies across communities due to sustainability of services in the absence of an acute inpatient base. In turn, sustainability will be a function of community resources (e.g., clinics that remain open in the community), market characteristics that attract new alternatives (e.g., population size, mix of insurance coverage among the population), proximity to urban centers, inclusion in a regional geography subject to health system expansion, and local circumstances precipitating closure (e.g., community support for the hospital).

Our empirical analysis will test the following hypotheses. Hypothesis 1: Ceasing hospital inpatient care services is correlated with the following community characteristics: declining total population in the service area, declining population of adults ages 25 – 64 (most likely to be insured under private plans), and increased unemployment. Hypothesis 2: Ceasing hospital inpatient care services is correlated with the following market characteristics: presence of other inpatient services within 25 miles of the site, entry of a regional healthcare system into the service area. Hypothesis 3: Reconfiguration of healthcare services occurs in rural communities losing hospital inpatient care services as a function of population and market characteristics.

Publications

• Health Care Professional Workforce Composition Before and After Rural Hospital Closure
  Policy Brief
  RUPRI Center for Rural Health Policy Analysis
  Date: 04/2020
  This policy brief examines the composition of the local healthcare workforce before and after rural hospital closure to reveal any associations with discontinuation of inpatient services in rural communities.