The Impact of Rural Hospital Closures and Mergers on Health System Ecologies: A Scoping Review.

Area of Science:

• Health Services Research
• Rural Health Policy
• Health Systems Analysis

Background:

• Rural hospitals are vital for community health and local economies in the United States.
• These critical facilities face high rates of closure and merger with larger health networks.
• Understanding the multifaceted impacts of these changes is crucial for maintaining rural healthcare access.

Purpose of the Study:

• To conduct a scoping review of the impacts of rural hospital closures and mergers in the U.S. since 2010.
• To identify existing knowledge and critical knowledge gaps concerning these health system changes.
• To introduce a novel research tool, the Health System Ecologies Impact Matrix, for assessing health system changes.

Main Methods:

• A comprehensive literature search was conducted to identify studies published since 2010.
• Included studies were analyzed to understand the reported impacts of rural hospital closures and mergers.
• The Health System Ecologies Impact Matrix was inductively developed from the reviewed literature.

Main Results:

• Most studies focused on rural hospital closures, predominantly reporting community-level impacts.
• Significant knowledge gaps exist regarding financial, workforce, and utilization outcomes of closures.
• Impacts of rural hospital mergers are less studied, with research focusing mainly on financial and utilization outcomes for the merged entity, neglecting patient and social environment effects.

Conclusions:

• While community impacts of rural hospital closures are documented, financial, workforce, and utilization impacts require further investigation.
• The effects of rural hospital mergers on patients and their social environments remain largely unexplored.
• The Health System Ecologies Impact Matrix offers a framework for future research into health system changes.