Review of Rural U.S. Economic and Health Care Trends


This report reviews recent literature and publicly available data to explore important issues at the nexus of health care and local economic vibrancy. The report also explores the economic implications associated with COVID-19, however full impacts will not be known for several years.

Key Takeaways

  • Rural America is diverse. Parts of Rural America (Western United States) are experiencing population growth and others (Rural South, Appalachia, Native Lands) continue to see a decline in population. Many of those communities facing population loss are also persistent poverty communities (communities in poverty over several decades).
  • There have been 140 rural hospital closures between January 2010 and July 2022. While some facilities have converted to other health care purposes, the majority have completely shut down. Closures impact access to emergency care due to increased ambulance times and, as a result, can affect the ability to address life threatening issues in a timely manner.
  • There are additional losses to a community associated with a rural hospital closure including both the loss of hospital spending as well as a reduction in employee spending (due to a loss of employment). Other industries including restaurants, professional services, and other healthcare services are negatively impacted when a rural hospital closes or contracts in size.
  • Rural ambulance services are facing significant challenges including reimbursement, workforce, and funding for operations. The closure of rural hospitals further exacerbates these issues.
  • There continues to be a shortage of health professionals in many rural areas. For some professions, there is an excess supply of providers in urban areas and a shortage in rural places. Recruitment and retention continues to be a top priority.
  • Those states that opted to expand Medicaid have lower uninsured rates (in both rural and urban areas). Insurance premiums through health insurance markets continue to climb as number of insurance companies decline.
  • Telehealth has emerged as an important mechanism for delivering patient care, particularly through COVID-19. The lack of broadband access in many rural communities continues to be of utmost concern. In addition, the quickly changing policy landscape determining reimbursement remains of keen interest to providers.
Center for Economic Analysis of Rural Health
Alison Davis