From the U.S. Government Accountability Office, www.gao.gov

Transcript for: Rural Hospital Closures

Description: In this podcast, we discuss what trends GAO found in rural
hospital closures.

Related GAO Work: GAO-18-634: Rural Hospital Closures: Number and
Characteristics of Affected Hospitals and Contributing Factors

Released: September 2018


[ Background Music ]

[ James Cosgrove: ] Not just rural hospitals, but all hospitals are
facing increased competition from other kinds of healthcare providers.

[ Matt Oldham: ] Welcome to GAO's Watchdog Report, your source for news
and information from the U.S. Government Accountability Office. I'm Matt
Oldham. It can be more difficult for Americans in rural areas to see a
doctor. For example, distance becomes more of a factor the farther you
get from our cities. So, you can imagine what closing a rural hospital
would mean for people living in its vicinity. The Department of Health
and Human Services collects data on hospital closures across the
country, and James Cosgrove, a director on our Health Care team, lead a
GAO report which analyzed this HHS data looking for trends in rural
hospital closures. Thank you for taking time to speak with me, James.

[ James Cosgrove: ] Thank you for having me.

[ Matt Oldham: ] So, what did you find out? Are rural hospitals more
likely to close than urban or suburban ones?

[ James Cosgrove: ] The short answer is yes. We looked at a five-year
period, recent five-year period, 2013 to 2017, and we saw that 64 rural
hospitals had closed. That's twice as many rural hospitals that had
closed compared to the previous five-year period. And, in contrast to
urban areas, it was both a higher number of rural hospitals that were
closed and a higher percentage of rural hospitals that were closed. And,
if we look at geography,they were disproportionally occurring in the
south, and also the type of hospital mattered. So, we found, for
example, that for profit rural hospitals were more likely to close
relative to government owned or not for profit rural hospitals.

[ Matt Oldham: ] Is there any insight as to why these hospitals are
closing?

[ James Cosgrove: ] Well, the short answer is financial distress. So,
these hospitals were either making a loss or earning less money than the
hospitals that remained open. And, again, I mean, there are several
things that come into play here. Hospitals, not just rural hospitals,
but all hospitals, are facing increased competition from other kinds of
healthcare providers. And, it's also during this time period that the
rural population was declining. So, again, I mean, that decreases the
patient base for rural hospitals.

[ Background Music ]

[ Matt Oldham: ] So, it sounds like hospitals in certain categories have
been more at risk of shutting down. Those that are in the south and
those that are for profit have more closures. James, what's next?

[ James Cosgrove: ] We need to understand how have these closures
affected access. So, this report, we've learned something about the
number of hospitals that have closed, where they've closed, and some of
the factors that might have contributed. Now, rural areas are different
from urban areas, as you mentioned at the beginning of the segment, in a
number of important ways. There's a higher percentage of the elderly
population, and they typically need more services. There's a higher
percentage of individuals that have limitations because of chronic
conditions. They need more healthcare services. And, there tend to be
lower household incomes. So, rural areas are just different. So, what we
plan to do, and this is a follow-on work that we're just starting now,
is look at this key issue. How have closures affected access.

[ Matt Oldham: ] Lastly, what do you believe is the bottom line of your
report?

[ James Cosgrove: ] The bottom line is that one in five Americans right
now live in rural areas. Many of those people who live there are
particularly vulnerable to hospital closures, and what we saw is that in
these areas, there was an increase in hospital closure that was higher
than what they saw in the previous five years and higher than what we
observed in urban areas. And so, it's important to keep digging behind
these questions and the next one we're going to get to is, well, how has
access been affected.

[ Matt Oldham: ] James Cosgrove is a director on our Health Care team,
and he was talking about a report looking into trends in rural hospital
closures. Thank you for your time, James.

[ James Cosgrove: ] Thank you.

[ Background Music ]

[ Matt Oldham: ] And thank you for listening to the Watchdog Report. To
hear more podcasts, subscribe to us on Apple Podcasts.

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[ Matt Oldham: ] For more from the congressional watchdog, the U.S.
Government Accountability Office, visit us at gao.gov.