U.S. hospital closures outpace openings in rural and urban communities

More hospitals across the U.S. are closing than opening, and urban hospitals are closing at the same rate as rural ones, according to a new study led by Harvard T.H. Chan School of Public Health. Further, the hospitals that close are more likely to be those serving socially vulnerable communities.

The findings will be published in a research letter in JAMA on Oct. 8.

Since the passage of the "One Big Beautiful Bill Act" that included changes to Medicaid policy, hospitals have been bracing to lose billions in funding, and concern has been growing over potential hospital closures. Most of this concern has been centered on rural hospitals, such that Congress created the Rural Health Transformation Program, providing billions in state grants for these hospitals. But whether hospital closures are actually concentrated in rural areas has been little studied and remains largely unknown.

The researchers sought to fill this gap and provide a current, comprehensive picture of U.S. hospital closures and openings. To do so, they analyzed data from the American Hospital Association annual survey, characterizing hospital closures and openings occurring from 2010 to 2025.

They found that hospital closures increased by 4% year over year, and openings decreased 3% year over year, with 432 hospitals closing and only 216 opening. The result was a net loss of 216 hospitals and more than 24,000 beds. There was no significant difference between rural and urban hospital closure rates.

The researchers also observed that the hospitals that more often closed were for-profit, small, and safety-net, and those in the most socially vulnerable counties-in both rural and urban areas. Safety-net hospitals and those serving a high number of Medicaid patients rarely opened.

"Many policymakers have been treating hospital closures as a rural problem, but our data show it's a national problem," said corresponding author Thomas Tsai, associate professor of health policy and management and co-director of the Healthcare Quality and Outcomes Lab. "We must shift away from only asking ourselves how we can save rural hospitals, and start asking: How do we protect access to hospital care for vulnerable communities, wherever they are?"