Exploring the Impact of Rural Hospital Closures on Use of Emergency Medical Services

Research center:
Lead researcher:
Project funded:
September 2016
Project completed:
October 2017

Since 2010 over 70 hospitals have closed their emergency department doors or the entire hospital. These closures have primarily occurred in the southern United States, but the closures are expected to broaden around the country and more than 250 hospitals are vulnerable to closure. In the wake of such closures, access to a hospital for real emergencies—and the distance and time to the next nearest hospital—could mean the difference between life and death. We expect to see increased reliance on Emergency Medical Services (both air and ambulance) to transport patients further distances at high cost. Rural, lower-income households and older individuals tend to use the emergency department more than others; thus the impact of rural hospital closures will likely disproportionately affect these same populations. Additional considerations include the non-uniform geographic distribution of rural hospitals and how emergency transportation service resources in a community are affected by a rural hospital closure. Using a unique national database, The Enterprise Data Trust, we will explore pre- and post-closure emergency department use with specific emphasis on those who used public emergency medical transportation, testing for significant changes. This study will be the first to look at the impacts of rural hospital closure at the patient level.


  • Ambulance Services for Medicare Beneficiaries: State Differences in Usage, 2012-2014
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 10/2017
    Ambulance services are at risk of scaling back or dissolving in some places. We analyzed Medicare beneficiaries’ use of ambulance services across the U.S. Improved understanding of how beneficiaries, most of whom are elderly, use these services provides vital information for policymakers who set rules and regulations about access to the services.