The financial pressures leading to rural hospital closures will likely continue. Hospital closures can reduce local healthcare infrastructure, and thus reduce access to locally available services. This trend disproportionately affects rural residents, who are on average older, poorer, and sicker than urban and suburban residents. Therefore, not only ingenuity but also creative investment and financing are required to design and sustain an appropriate menu of local healthcare services. Rural places can be innovators of new healthcare delivery models when supported by committed local leadership, strong community backing, creative program design, and innovative payment policies.

This paper describes opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from centering on inpatient hospital-based care to new models of care delivery in rural places. Communities with hospitals that are vulnerable to closure may also find the approaches outlined here constructive when considering options for optimal care delivery. The health services delivery options are synthesized into two categories: currently available options under existing Federal and State laws governing healthcare structures and payments, and new ideas that are policy options under consideration introduced by various policy stakeholders in response to the crisis that closures have created for many rural communities. The policy options under consideration would promote delivery arrangements that require new laws and/or Federal and State regulations and payment arrangements.