Deaths rise after rural hospitals close, University of Minnesota study finds

Study is among first to link closures of rural hospital to higher mortality rates.

September 27, 2019 at 9:37AM
In this April 25, 2014 photo, a sign points the way to Flint River Hospital which closed its emergency room last year, in Montezuma, Ga. Residents must now drive 20 or 30 miles on slow country roads to the nearest hospital. Alarmed by hospital closures, health officials in Georgia are changing rules to let stressed rural hospitals become expanded emergency rooms that can also handle routine childbirths or outpatient surgery. (AP Photo/David Goldman) ORG XMIT: GADG213
In this April 25, 2014 photo, a sign points the way to Flint River Hospital which closed its emergency room in Montezuma, Ga. (The Minnesota Star Tribune)

Elderly patients are more likely to die when the nearest rural hospital closes and they have to travel farther for treatment of time-sensitive conditions such as heart attacks and strokes, according to a study by a new University of Minnesota health economist.

The study is among the first nationally to link higher mortality rates with rural hospital closures, which have been happening with increasing frequency.

At least 113 rural U.S. hospitals have closed since 2010; Minnesota has mostly escaped the trend.

"When I zoom in to look at patients with time-sensitive health conditions, I find that they do worse when their [nearest] hospitals close," said Caitlin Carroll, who conducted the research for her doctorate at Harvard University. She was recruited to the U's School of Public Health this summer.

Carroll also found that many small hospitals averted closure by getting federal "critical access" designation, which qualifies them for higher payments from the federal Medicare program. Those hospitals saw reductions in mortality.

That is a significant finding for Minnesota, which has the fourth-most critical access hospitals in the nation.

However, those mortality reductions came at a steep cost. Her research also found that most rural hospitals probably could have stayed open without the higher payments. So it's possible that many lives could have been saved with considerably less federal hospital spending.

Carroll's research undercut some theories, including the proposition that rural patients might do better after a hospital closes because they would travel farther for higher-quality care.

That wasn't the case. "The second closest hospital is another small facility that looks pretty much the same [as the first closest] on quality metrics," she said.

Carroll's study was based on a review of Medicare recipients who lost their closest hospitals and then needed inpatient treatment for time-sensitive conditions. She compared them with patients in the same regions for whom the closed hospitals were only second closest.

Deaths increased only among those who lost their closest hospitals, reflecting the fact that many were in their 80s and struggled to travel longer distances for medical care.

Carroll then looked specifically at patients who had to travel an additional 15 miles or more for time-sensitive care after their closest hospitals shut down. The death rate increased 10% in this group.

Jeremy Olson • 612-673-7744 • @stribjo

Caitlin Carroll of the University of Minnesota's Division of Health Policy and Management.
Caitlin Carroll of the University of Minnesota's Division of Health Policy and Management. (Vince Tuss/The Minnesota Star Tribune)
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about the writer

Jeremy Olson

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Jeremy Olson is a Pulitzer Prize-winning reporter covering health care for the Star Tribune. Trained in investigative and computer-assisted reporting, Olson has covered politics, social services, and family issues.

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