Rural Hospitals: Federal Efforts Should Target Areas Where Closures Would Threaten Access to Care
HRD-91-41
Published: Feb 15, 1991. Publicly Released: Feb 15, 1991.
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Highlights
Pursuant to a congressional request, GAO examined the causes and consequences of rural hospital closures, focusing on the: (1) major factors associated with a higher risk of closure; (2) impact of hospital closure on rural communities and health care costs; and (3) role of Medicare in closures.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| To assist rural communities in maintaining access to essential hospital services in an effective and efficient manner, Congress should consider making any future transition grant funding for this purpose available contingent upon a determination that where continued provision of essential services is threatened, but the hospital is not a viable entity, Congress should consider making any future transition grant funding available to state or local governments to support other initiatives to strengthen access to inpatient or emergency health care (for example, by improving transportation systems or training emergency personnel). |
Closed – Not Implemented
|
Congress has taken no action on this recommendation. The rural hospital issue has been subsumed in a broader debate on health care reform. It is unlikely that the rural issues will be dealt with separately. |
| To assist rural communities in maintaining access to essential hospital services in an efficient and effective manner, Congress should consider making any future transition grant funding for this purpose available contingent upon a determination that: (1) the hospital is providing inpatient or emergency services essential for the community as a whole or for vulnerable populations; (2) the continued provision of essential services is threatened by the hospital's financial problems; and (3) the total amount of funding, including proposed federal and other funding sources, would be sufficient to give the hospital a reasonable chance for survival. |
Closed – Not Implemented
|
No congressional action is anticipated. |
Recommendations for Executive Action
| Agency Affected | Recommendation | Status Sort descending |
|---|---|---|
| Department of Health and Human Services | To identify areas threatened with loss of access to essential hospital services, when hospital closure might still be avoided, the Secretary of Health and Human Services should direct the Office of Rural Health Policy (ORHP) to develop guidelines for states to identify and monitor rural areas in which hospitals are at a risk of closure and vulnerable populations, such as low-income residents, or the community as a whole would face substantial problems in obtaining essential inpatient or emergency care if the hospital closed. |
Closed – Not Implemented
ORHP does not have the resources to do primary research from which to develop guidelines. It will be conducting a literature review of key indicators to share with state offices of rural health policy. It does not intend to proceed further at this time.
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Topics
Community hospitalsDisadvantaged personsEconomic analysisFederal aid programsHealth care facilitiesHealth resources utilizationHospital administrationHospital care servicesMedicareRural hospitalsRural economic development