Over the past two decades, nearly 200 rural hospitals have closed, resulting in millions of Americans losing access to an emergency room, inpatient care, and other hospital services. And today, more than 700 rural hospitals in the U.S. – or approximately 1 in 3 – are at risk of closing due to financial problems, according to a report from the nonprofit Center for Healthcare Quality and Payment Reform. 

All this comes at a time when rural health disparities are rampant. In the final episode of our rural health series, we consider solutions: What does it take to prevent rural hospital closures? What evidence-based solutions can policymakers consider to ensure all Americans have access to critical health services, regardless of where they live?

Health Disparities podcast host Bill Finerfrock speaks with Harold Miller, president and CEO of the Center for Healthcare, Quality and Payment Reform and adjunct professor of public policy and management at Carnegie Mellon University. 

Miller says many people assume that when a rural community loses a hospital, it’s one of several options, when in reality, “in many small rural communities, the hospital is the only place to get any kind of health care. It is the only place where, not only where there is an emergency department, but because there's no urgent care facility in the community, there's no other place to get a lab test, there may not even be primary care physicians in the community.”

When it comes to policy considerations to prevent rural hospital closures, Miller says there need to be a greater emphasis on the role private health insurance plans play in putting hospitals at risk.

“The myth, unfortunately, is that the problem of rural hospital payment is all about Medicare and Medicaid, and that has led people to focus, I believe, inappropriately and excessively, on Medicare and Medicaid,” he says, “when what we have found is that the biggest problem for most rural hospitals is private insurance plans who don't pay the rural hospital even as much, in many cases, as Medicare or Medicaid does. … We need to start thinking about how to solve the real problems and to solve them now, rather than waiting until the hospital is faced with closure.”

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