In examining the effect of rural hospital closure on community life, concerns are raised regarding the role of hospitals and physicians in aiding vulnerable communities in transition, according to study results published in the AMA Journal of Ethics.

The increased closure of rural hospitals leaves many patients without care. The investigators of this case study sought to understand the vulnerability of rural patients, the impact of rural hospital closures, and the ethical responsibility of hospitals and physicians during and after closure. The investigators suggested that health networks should partner with community members to identify remaining gaps in the access and delivery of healthcare services and to help the communities transition to new service locations.

Understanding Rural Patients’ Vulnerability to Hospital Closures

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Socioeconomic factors are responsible for nearly half of all health outcomes; poverty and inadequate transportation are some of the primary factors that make rural patients vulnerable to hospital closures, especially as rural residents rely more on their local hospital for different care services. These vulnerabilities are exacerbated by race and ethnicity, gender identity, and age. Racial and ethnic minorities in rural areas are more likely to report poorer health outcomes, obesity, and foregoing health care; risk for mental illness in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people is significantly compounded by geographical isolation and limited mental health resources; and the rural elderly are challenged by higher poverty rates, inadequate housing, and isolation.

Understanding the Impact of Rural Hospital Closures

Beyond providing access to quality health care, rural hospitals are identified as making additional contributions to a community’s well-being: They serve as a major employer and career ladder for local residents and provide a general sense of reassurance and security. The impact of a rural hospital closure not only places its residents at increased risk for poor health outcomes but also leads to a decrease in per capita income.

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Responsibility in the Decision to Close a Rural Hospital

Faced with the decision of whether to close a rural hospital, healthcare organizations should consider the potential impact — emotional, economic, practical, and political — on the community and the healthcare organization itself. The investigators recommend that in the event of a hospital closure, an advisory group including both hospital and community stakeholders should develop and oversee a closure process and plan.

In addition, although local physicians must cope with their own feelings over the closure, they are responsible for discussing with their patients appropriate steps to ensure continuity of care, as well as mitigate potential patient backlash. It is critical to have a clear communication network in place and to commit to consistent messaging about the reason for closure and the plan for transition.  


Holmes GM, Thomas SR. What should be the scope of a health network’s obligation to respond after a hospital closure? AMA J Ethics. 2019;21(3):E215-E222.