The Impact of Urban Hospital Closures on Surrounding Communities: A Systematic Review

Urban hospital closures have accelerated in the USA over the past few decades. These hospitals serve as safety-net providers, offering essential care and employment in resource-limited neighborhoods. Closure of these hospitals disproportionately affects socioeconomically disadvantaged and minority communities. Despite growing concerns, the effects of urban hospital closures on population health, access to care, and community stability are not fully understood.

We conducted a systematic review of peer-reviewed and grey literature examining the effects of urban hospital closures in the USA. Databases searched included MEDLINE, Scopus, Web of Science, CINAHL, EconLit, Business Source Complete, Cochrane Library, and HCUP publications, covering 1961-2024. Studies were included if they evaluated the impact of full hospital closures in urban settings on access to care, health outcomes, or local economic indicators. Studies were assessed with the Quality Assessment for Diverse Studies (QuADS) tool.

Twenty-four studies met inclusion criteria-17 quantitative and 7 qualitative. Closures were concentrated in socioeconomically disadvantaged and racially diverse neighborhoods. Quantitative outcomes included increased travel distances and wait times, reduced access to emergency and specialty care, and greater reliance on distant tertiary centers. Overall findings were mixed regarding population wide and infant mortality rates in areas affected by hospital closure. Qualitative outcomes included substantial disruptions to care continuity, workforce displacement, and loss of hospitals as community anchors. Impacts were greatest among uninsured, Medicaid, elderly, and minority populations.

Urban hospital closures amplify existing inequities in healthcare access and outcomes. Anticipated federal Medicaid cuts, however, may further accelerate closures. Policy measures such as Medicaid stabilization, early identification of at-risk hospitals, and improved transition planning may mitigate harms related to closure.