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Online Journal of Rural Nursing and Health Care, 14 (2) 
http://dx.doi.org/10.14574/ojrnhc.v14i2.354                                                                             1 
 

Editorial 

Rural Hospitals Endangered?   

Pamela Stewart Fahs, RN, DSN, Editor 

If you were working in health care in the 1980’s and 1990’s the current headlines and 

webinars on the closures of rural hospitals may give you a sense of déjà vu.  A 2014 headline in 

the USA today read “Rural Hospitals in Critical Condition”. O’Donnell and Ungar went on to 

report that 43 rural hospitals have closed since 2010 and that that the rate of closure is 

intensifying.  This data comes from the North Carolina Rural Health Research Program where a 

national study is being conducted on hospital closures. You can access an archived webinar 

http://www.ruralhealthresearch.org/alerts/archive/42 on the Rural Health Research & Policy 

Center website (Holmes, 2014) which includes their research on issue of profitability and closure 

of rural hospitals. 

Remember why the Critical Access Hospital (CHS) program was created? As hospitals 

began to receive prospective payment vs. reimbursement for cost, there was a rash of hospital 

closures, and these closures were occurring disproportionately in rural areas. These closures 

made access to health care in rural populations problematic but were also a financial strain on the 

rural communities themselves.  Rural hospitals are often a major employer in rural communities. 

Critical Access Hospitals have higher reimbursements than usual, which have helped many 

survive; however, these reimbursement rates are under review. Even with the high level of 

reimbursement CAHs are operating on slim profit margins. What these facilities bring to rural 

communities, is available health care and peace of mind – someone is there to provide care 24 

hours per day.  They are critical indeed to the rural populations they serve. The care in CAHs 

should be high quality and these hospitals have a responsibility to assess and maintain quality of 



Online Journal of Rural Nursing and Health Care, 14 (2) 
http://dx.doi.org/10.14574/ojrnhc.v14i2.354                                                                             2 
 

care. There may well be some rural hospitals that need to close but many provide a valuable 

service and help to meet the basic goal underlying the Affordable Care Act, access to care.  

References 

Holmes, M. (2014). Change in profitability and financial distress of CAHs from loss of cost-based 

            reimbursement. Retrieved from http: www.ruralhealthreserach.org/alerts/arechive/43 

O’Donnell, J. & Ungar, L. (2010) USA Today special report: Rural hospitals in critical   

            condition.