Title: Hospital Closures Hit Cities as Often. Who Travels Farther?
Author: Arthur Harmash
Published: 2026-10-09
Source: https://lymyvoyage.com/articles/hospital-closures-cities-rural-travel
Citations:
- https://www.beckershospitalreview.com/finance/urban-rural-hospitals-closing-at-comparable-rates-study/
- https://www.yahoo.com/news/us/articles/urban-rural-hospitals-closing-similar-150155318.html
- https://www.wfae.org/2015-05-04/when-hospitals-close-frequent-fears-about-care-arent-realized
- https://www.gao.gov/products/gao-21-93
- https://www.iza.org/publications/dp/12797/hospital-closures-and-short-run-change-in-ambulance-call-times
- https://news.harvard.edu/gazette/story/newsplus/health-in-communities-may-not-suffer-after-hospital-closings/
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2026.36325
- https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2026.18260
- https://www.aha.org/news/headline/2025-07-21-cbo-projects-obbba-increase-uninsured-10-million-federal-deficit-34-trillion
- https://www.washingtonpost.com/nation/2026/10/08/hospitals-are-closing-across-america-its-only-getting-worse/
---
The US has more hospitals closing than opening, and the losses are not confined to the countryside. A research letter published in *JAMA* on October 8, 2026, tracked 4,962 acute care hospitals from 2010 to 2025. It found 432 closures and 216 openings, a net loss of 216 hospitals and 24,399 beds.[^1]
Policy has treated closures mostly as a rural problem, but the new data says city hospitals closed at about the same rate. What changes with location is the cost a closure passes on to patients, and only part of that cost has been measured.
Hospital closures are usually called a rural problem. A Harvard study of 2010 to 2025 found city hospitals closed just as often. So who ends up traveling farther?
The rates are close: 9.1% of urban hospitals closed, against 8.3% of rural ones. The travel burden is not. After 64 rural closures, a federal audit found the median trip to inpatient care grew by about 20 miles. One study found urban ambulance trips barely changed.
A closure is not always deadly. A 2015 Harvard study of 195 closures found Medicare death rates unchanged, likely because patients moved to nearby hospitals with better finances. A 2026 Texas study of 14 rural closures found time-sensitive deaths rose about 5%.
What the data cannot show yet: the new study also measured the distance to the nearest hospital after each closure. That result is behind a paywall. No source reviewed here gives a national figure for how far city patients now travel.
US hospitals close at similar rates in cities and rural areas. The measured travel penalty is rural. In cities, the cost shows up as transfers, longer waits and specialists leaving the area, and no source reviewed here counts it in miles.
## Which hospitals close
Ownership separates closing hospitals much more sharply than geography does. For-profit hospitals closed at 21.4% over the period, against 6% for nonprofits, according to Becker's Hospital Review's account of the letter.[^1] The urban and rural rates, 9.1% and 8.3%, were not statistically different.[^1]
Small, safety-net and nonteaching hospitals were also more likely to close. Safety-net hospitals are the ones that treat large numbers of poor and uninsured patients. Closures clustered in the counties with the highest social vulnerability.[^1] Stateline reports that most closures were in the Midwest and South, and in states that did not expand Medicaid.[^2]
Not every closure removes a building. The study counted a hospital as closed once it stopped inpatient care. Of the 432, 315 shut completely and 117 kept outpatient services, including 45 that became rural emergency hospitals.[^1] A rural emergency hospital treats emergencies but no longer admits patients overnight.
The pattern is not new. A 2015 Harvard study of 195 closures from 2003 to 2011 found 70% were in urban areas, and a third were safety-net hospitals.[^3] Two studies, a decade apart and on different datasets, point the same way.
## How far patients travel after a closure
| Study | Setting | What changed after closures |
|---|---|---|
| Government Accountability Office, 2020 | 64 rural closures, 2013 to 2017 | Median distance to inpatient care rose from 3.4 to 23.9 miles |
| Institute of Labor Economics working paper, 2019 | Ambulance records, rural and urban | Rural trips 15.7 minutes longer (46%); urban change small |
| Joynt and colleagues, *Health Affairs*, 2015 | 195 closures, mostly urban | Medicare patients treated outside their area rose from 43% to 54% |
The clearest distance figure is rural. The Government Accountability Office studied residents near 64 rural hospitals that closed between 2013 and 2017. Their median distance to general inpatient care rose by 20.5 miles. For alcohol and drug treatment, it rose by 39.1 miles.[^4]
Ambulance records tell the same story in minutes. A 2019 working paper from Germany's Institute of Labor Economics found rural patients spent 15.7 more minutes in total response time after a closure, a 46% increase. Almost all of it was the drive to the next hospital. Urban patients saw only a small change.[^5]
For city closures, the measured effect is patients moving rather than longer trips. In the 2015 Harvard study, the share of Medicare patients hospitalized outside their own area rose from 43% before a closure to 54% after.[^3] Thomas Tsai, the new letter's corresponding author, told the Washington Post that wait times swell as patients are transferred. Surgeons and other specialists also lose their workplace.[^10]
## What the headline numbers leave out
Distance is not the same as harm, and the evidence here points both ways. The 2015 study found Medicare death rates unchanged after closures, compared with similar areas where no hospital closed. Its lead author, Karen Joynt, suggested patients went to nearby hospitals with better finances.[^6] It measured Medicare patients only, so it says little about the uninsured patients safety-net hospitals serve.[^3]
A 2026 study of Texas points the other way for rural areas. It followed 14 rural closures and found 12 more deaths per 100,000 residents each year from heart attack, stroke, sepsis and lung disease. That is a 5.4% rise over the baseline death rate in the counties affected.[^7]
The new *JAMA* letter also measured changes in distance to the nearest hospital after closures.[^8] Those results sit behind the journal's paywall and were not in any coverage reviewed for this article. So no figure here tells you how far city patients now travel.
The next pressure is financial. The Congressional Budget Office projects the 2025 budget law will leave 10 million more people uninsured by 2034. It puts the federal spending cut for Medicaid and the insurance marketplaces at $1.06 trillion.[^9] Stateline reports $886.8 billion in Medicaid cuts alone.[^2] The two figures differ because the larger one includes the marketplaces.
## How to use these numbers
Check who owns your local hospital, and whether it is a safety-net hospital. On this data, those two facts predict closure better than whether you live in a city.
Know your second-nearest hospital and the drive to it, because that distance is what the Government Accountability Office measured after rural closures.
If your hospital converts to a rural emergency hospital, it can still treat an emergency but can no longer admit you. For planned surgery, ask your surgeon where else they operate before you need to know.
[^1]: https://www.beckershospitalreview.com/finance/urban-rural-hospitals-closing-at-comparable-rates-study/ — Becker's Hospital Review, "Urban, rural hospitals closing at comparable rates: Study," citing Calianos et al., JAMA (published Oct 2026). Accessed Oct 9, 2026.
[^2]: https://www.yahoo.com/news/us/articles/urban-rural-hospitals-closing-similar-150155318.html — Stateline (syndicated by Yahoo News), "Urban, rural hospitals closing at similar rates, study finds" (published Oct 2026). Accessed Oct 9, 2026.
[^3]: https://www.wfae.org/2015-05-04/when-hospitals-close-frequent-fears-about-care-arent-realized — KFF Health News via WFAE, "When Hospitals Close, Frequent Fears About Care Aren't Realized," citing Joynt et al., Health Affairs (published May 2015). Accessed Oct 9, 2026.
[^4]: https://www.gao.gov/products/gao-21-93 — US Government Accountability Office, "Rural Hospital Closures: Affected Residents Had Reduced Access to Health Care Services" (GAO-21-93, published Dec 2020). Accessed Oct 9, 2026.
[^5]: https://www.iza.org/publications/dp/12797/hospital-closures-and-short-run-change-in-ambulance-call-times — IZA Institute of Labor Economics, Chaudhary, Davis, Troske and Troske, "Hospital Closures and Short-Run Change in Ambulance Call Times" (Discussion Paper 12797, published Nov 2019). Accessed Oct 9, 2026.
[^6]: https://news.harvard.edu/gazette/story/newsplus/health-in-communities-may-not-suffer-after-hospital-closings/ — Harvard Gazette, "Health in communities may not suffer after hospital closings" (published May 2015). Accessed Oct 9, 2026.
[^7]: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2026.36325 — JAMA Network Open, Poisler and Gujral, "Rural Hospital Closures and Mortality From Time-Sensitive Conditions in Texas" (published Sep 2026). Accessed Oct 9, 2026.
[^8]: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2026.18260 — JAMA, Calianos, Song, Orav, Figueroa and Tsai, "Longitudinal Trends and Characteristics of Hospital Closures and Openings" (published Oct 2026). Accessed Oct 9, 2026.
[^9]: https://www.aha.org/news/headline/2025-07-21-cbo-projects-obbba-increase-uninsured-10-million-federal-deficit-34-trillion — American Hospital Association, "CBO projects OBBBA to increase uninsured by 10 million, federal deficit by $3.4 trillion," citing Congressional Budget Office estimates (published Jul 2025). Accessed Oct 9, 2026.
[^10]: https://www.washingtonpost.com/nation/2026/10/08/hospitals-are-closing-across-america-its-only-getting-worse/ — The Washington Post, Daniel Wu, "Hospitals are closing across America, and it's only getting worse" (published Oct 2026). Accessed Oct 9, 2026.