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
- 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
- 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
- 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.