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Hospital Closures Increase Emergency Care Travel Time: Rural-Urban Disparities.

Huiwen Zheng¹, Scott Horel², Christine Crudo Blackburn¹

¹Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, USA.

Inquiry : a Journal of Medical Care Organization, Provision and Financing

|June 12, 2026

Summary

Hospital closures significantly increase travel time to emergency departments (EDs), disproportionately impacting rural communities. Micropolitan, Small Town, and Rural areas face longer delays for emergency medical services compared to Metropolitan areas.

Keywords:

census tract emergency care hospital closures rural-urban disparities travel time

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Area of Science:

Health Services Research
Rural Health
Emergency Medicine

Background:

Access to emergency care is critical, especially for time-sensitive conditions.
Hospital closures reduce emergency department (ED) services, impacting community access.
Understanding the impact of closures on travel time is crucial for healthcare planning.

Purpose of the Study:

To assess the association between hospital closures and changes in travel time to EDs in Texas.
To analyze these changes across Rural-Urban Commuting Area (RUCA) categories.
To quantify the magnitude of travel time increases for affected populations.

Main Methods:

Utilized Texas hospital data (2012-2023) and 2020 U.S. Census data.
Calculated travel times to nearest and second nearest EDs using ArcGIS Pro 3.2.
Employed logistic and OLS regressions, controlling for geographic and socioeconomic factors.

Main Results:

Hospital closures led to increased travel times for 135 (nearest ED) and 263 (second nearest ED) census tracts.
Micropolitan, Small Town, and Rural areas showed a higher likelihood of increased travel time compared to Metropolitan areas.
Affected rural areas experienced significant increases in travel time to EDs, with Small Town areas seeing the largest increase (5.04 minutes).

Conclusions:

Hospital closures disproportionately burden rural communities by increasing travel time to emergency care.
Targeted interventions are needed to mitigate the impact of ED closures on rural populations.
Policy considerations should address healthcare access in underserved rural areas following hospital closures.