Rural Hospital Closures: Effects on Utilization and Medical Spending Among Commercially Insured Individuals.
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 06 2022
01 06 2022
Historique:
pubmed:
23
3
2022
medline:
18
5
2022
entrez:
22
3
2022
Statut:
ppublish
Résumé
Access to health care continues to be a challenge, especially in remote areas. Since 2013, 70 rural hospitals have closed in the United States further exacerbating barriers to health care access in rural areas. The objective of this study is to identify the impact of rural hospital closures on total medical spending and utilization among the commercially insured rural population. We use a pre-post study design with a comparison group. Individual-level Texas commercial claims data in 2014-2019 were linked to the Centers for Medicare & Medicaid Services (CMS) Provider of Services Current Files, Area Health Resource File, and Census American Community Survey. We performed an event study to test for pre-trends. Analysis sample included commercially insured individuals 19-64 years of age residing in Texas. Total medical spending and counts of health care encounters. Individuals residing in rural Texas areas affected by a hospital closure experienced decreases in outpatient and emergency department (ED) utilization and no statistically significant changes in total medical spending relative to the unaffected individuals. Outpatient and ED utilization decreased by 0.133 (<0.1) and 0.015 (7<0.05) visits, respectively. Heterogeneity analysis showed that individuals residing in urban Texas experienced increases in total medical spending by $12.2 per month (<0.01) as well as individual spending subcategories. Rural hospital closures led to significant decreases in outpatient and ED utilization while having no effect on health care spending. Close attention must be paid to rural hospital closures to ensure equitable health care access, especially for underserved populations.
Sections du résumé
BACKGROUND
Access to health care continues to be a challenge, especially in remote areas. Since 2013, 70 rural hospitals have closed in the United States further exacerbating barriers to health care access in rural areas.
OBJECTIVE
The objective of this study is to identify the impact of rural hospital closures on total medical spending and utilization among the commercially insured rural population.
RESEARCH DESIGN
We use a pre-post study design with a comparison group. Individual-level Texas commercial claims data in 2014-2019 were linked to the Centers for Medicare & Medicaid Services (CMS) Provider of Services Current Files, Area Health Resource File, and Census American Community Survey. We performed an event study to test for pre-trends.
SUBJECTS
Analysis sample included commercially insured individuals 19-64 years of age residing in Texas.
MEASURES
Total medical spending and counts of health care encounters.
RESULTS
Individuals residing in rural Texas areas affected by a hospital closure experienced decreases in outpatient and emergency department (ED) utilization and no statistically significant changes in total medical spending relative to the unaffected individuals. Outpatient and ED utilization decreased by 0.133 (<0.1) and 0.015 (7<0.05) visits, respectively. Heterogeneity analysis showed that individuals residing in urban Texas experienced increases in total medical spending by $12.2 per month (<0.01) as well as individual spending subcategories.
CONCLUSIONS
Rural hospital closures led to significant decreases in outpatient and ED utilization while having no effect on health care spending. Close attention must be paid to rural hospital closures to ensure equitable health care access, especially for underserved populations.
Identifiants
pubmed: 35315376
doi: 10.1097/MLR.0000000000001711
pii: 00005650-202206000-00007
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
437-443Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Carroll A. Healthcare triage: Rural hospital closures impact the health of a lot of people; 2019. Available at: https://theincidentaleconomist.com/wordpress/healthcare-triage-rural-hospital-closures-impact-the-health-of-a-lot-of-people/?MessageRunDetailID=90939764&PostID=3665339 . Accessed September 15, 2020.
Health Resources & Services Administration (HRSA). Hospital closings likely to increase; 2017 report. Available at: www.hrsa.gov/enews/past-issues/2017/october-19/hospitals-closing-increase.html . Accessed September 15, 2020.
Ellison A. Rural hospital closures hit record high in 2019—here’s why?; 2019. Available at: www.beckershospitalreview.com/care-coordination/why-rural-hospitals-are-closing.html#:~:text=As%20rural%20hospitals%20close%2C%20residents,two%20%E2%80%93%20to%20the%20nearest%20hospital . Accessed September 15, 2020.
Reif SS, DesHarnais S, Bernard S. Community perceptions of the effects of rural hospital closure on access to care. J Rural Health. 1999;15:202–209.
Wishner J, Solleveld P, Rudowitz R, et al. A look at rural hospital closures and implications for access to care: three case studies; 2016. Available at: www.urban.org/sites/default/files/publication/82511/2000857-brief-a-look-at-rural-hospital-closures-and-implications-for-access-to-care.pdf . Accessed September 15, 2020.
Hsia RYJ, Shen YC. Rising closures of hospital trauma centers disproportionately burden vulnerable populations. Health Aff. 2011;30:1912–1920.
Troske S, Davis A. Do hospital closures affect patient time in an ambulance? 2019. Available at: https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1007&context=ruhrc_reports . Accessed September 15, 2020.
Buchmueller TC, Jacobson M, Wold C. How far to the hospital? The effect of hospital closures on access to care. J Health Econ. 2006;25:740–761.
Gujral K, Basu A. Impact of rural and urban hospital closures on inpatient mortality. NBER Working Paper 26182; 2019.
Hart LG, Pirani MJ, Rosenblatt RA. Causes and consequences of rural small hospital closures from the perspectives of Mayors. J Rural Health. 1991;7:222–245.
Doeksen GA, Johnson T, Willoughby C. Measuring the economic importance of the health sector on a local economy: a brief literature review and procedures to measure local impacts. Report number: SRCD Number 202: Southern Rural Development Center; 1997.
Holmes GM, Slifkin RT, Randolph RK, et al. The effect of rural hospital closures on community economic health. Health Serv Res. 2006;41:467–485.
Lindrooth RC, Perraillon MC, Hardy RY, et al. Understanding the relationship between Medicaid expansions and hospital closures. Health Aff. 2018;37:111–120.
Kaufman BG, Reiter KL, Pink GH, et al. Medicaid expansion affects rural and urban hospitals differently. Health Aff. 2016;35:1665–1672.
Miller KE, James HJ, Holmes GM, et al. The effect of rural hospital closures on emergency medical service response and transport times. Health Serv Res. 2020;55:288–300.
Rosenbach ML, Dayhoff DA. Access to care in rural America: impact of hospital closures. Health Care Financ Rev. 1995;17:15.
Kaiser Family Foundation. Medicaid enrollees are sicker and more disabled than the privately-insured; 2013 report. Available at: www.kff.org/medicaid/slide/medicaid-enrollees-are-sicker-and-more-disabled-than-the-privately-insured/ . Accessed December 1, 2021.
Gotlieb EG, Rhodes KV, Candon MK. Disparities in primary care wait times in medicaid versus commercial insurance. J Am Board Fam Med. 2021;34:571–578.
Joynt KE, Chatterjee P, Orav EJ, et al. Hospital closures had no measurable impact on local hospitalization rates or mortality rates, 2003–11. Health Aff. 2015;34:765–772.
Bazzoli GJ, Lee W, Hsieh HM, et al. The effects of safety net hospital closures and conversions on patient travel distance to hospital services. Health Serv Res. 2012;47:129–150.