Clearing the Air Over Hospital Closings

I have a thing about hospital closings. This goes back to the late 1980s when I was a healthcare business reporter at Modern Healthcare. The American Hospital Association (AHA) began releasing an annual list of hospitals that closed, and the AHA blamed underpayments from Medicare for sinking the hospitals. In other words, the AHA used hospital closings to lobby Congress for more Medicare money for hospitals.

Well, it turned out that the AHA didn’t vet its evidence as thoroughly as it should have. Some hospitals on the list were still open. Others simply changed names. Many converted to other types of healthcare facilities like long-term acute-care hospitals or ambulatory care centers. Another reporter and I broke the story about the list being full of holes, and the AHA’s claim that Medicare was killing off hospitals was false.

The whole thing blew up. That ultimately led to HHS’ Office of the Inspector General (OIG) releasing an annual report on hospital closings and openings. The annual OIG report then replaced the annual AHA report as the most credible source of data on hospital closings and openings. The AHA stopped issuing its annual list of hospital closures. Then at some point, the OIG dropped its annual report, too, and no one seemed to notice or care.

That is, until a handful of researchers from the T.H. Chan School of Public Health at Harvard University decided to revisit the phenomenon of hospital closings and openings in a new research letter published in the Journal of the American Medical Association. They defined hospital closure as the loss of acute-care services either by converting to something else or shutting down completely.

Here are a few of the researchers’ study findings that I think buck conventional wisdom about the types of hospitals that close:

• 432 hospitals closed and 216 hospitals opened from 2010 through 2025 for a net loss of 216 hospitals, or an average of a little more than 14 per year over the 15-year study period.
• Of the hospitals that closed, 117, or 27.1%, continued to provide outpatient care, including 45 rural emergency hospitals.
• 43.3% of the closed hospitals were not-for-profits compared with 39.8% being for-profit and the rest being government owned.
• 53.2% of the closed hospitals were in urban markets compared with 46.8% in rural markets.
• 63.9% of the closed hospitals were affiliated with larger health systems compared with 36.1% being independent.
• Only 26.2% of the closed hospitals were safety-net hospitals.
• The median distance to the nearest hospital for people who live in a market where a hospital closed in 2025 was 6.9 miles.

Now, does all that fit the image you have of the typical closed hospital? I wouldn’t think so.

Hospitals are businesses like any other business in any other industry. Most hospitals close for the same reason most businesses close in any other industry: They don’t have enough paying customers.

Kudos to the researchers for this much-needed reality check on hospital closings. The study clears some of the smoke hospital lobbyists are still blowing at us.