Rural Hospital Closures, Hospital Spatial Accessibility, and Preventive Care Receipt in the US South: A
Arrianna Marie Planey1, Sandy Wong2, Fikriyah Winata3
1UNC Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina, Chapel Hill, McGavran-Greenberg, Chapel Hill, NC, USA. amplaney@email.unc.edu.
Journal of General Internal Medicine
|October 20, 2025
Summary
Rural hospital closures in the US South are linked to reduced preventive care access for older adults. This highlights the need for stronger primary care networks to ensure continued healthcare services.
Area of Science:
- Public Health
- Healthcare Management
- Rural Health Disparities
Background:
- Rural hospital closures have increased since 2010, disproportionately impacting primary care Health Professional Shortage Areas (HPSAs).
- Closures are associated with increased travel burdens and reduced primary care physician supply in rural areas.
- The impact of closures on primary care utilization among rural residents remains less understood.
Purpose of the Study:
- To evaluate the receipt of preventive healthcare services among rural-dwelling adults following hospital closures.
- To analyze the association between hospital closures and the utilization of preventive care in rural populations.
Main Methods:
- Generalized linear mixed models (GLMMs) were employed to assess relationships between hospital closures, spatial accessibility, primary care practitioner shortage, and preventive care receipt.
- The study analyzed data from 4275 rural Census tracts across 720 counties in the US South.
- Outcomes included the percentage of adults receiving routine preventive care, specific services for older men and women, and cholesterol screening, considering factors like travel time, distance to hospitals, and HPSA designation.
Main Results:
- Approximately 10% of analyzed tracts were in counties with hospital closures, and 26% were in adjacent counties.
- Counties experiencing two or more hospital closures showed a negative association with preventive service receipt in older adults (women: -4.9%, men: -3.8%).
- Average travel times and distances to the nearest hospitals were significant, indicating potential access barriers.
Conclusions:
- Policymakers and health systems must strengthen primary care networks in the US South due to high chronic condition prevalence and closure risks.
- Addressing rural hospital closures requires strategic interventions to maintain and improve access to essential preventive healthcare services.
- Bolstering primary care infrastructure is crucial for mitigating the negative health impacts of hospital closures on rural communities.
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