What happens when a hospital closes? A hospital in a rural area where there aren't a lot

of other hospitals nearby. This is a situation that tens of millions of Americans have faced

over the last two decades. Since 2005, more than 180 rural hospitals in the United States

have closed, and more than 800 rural hospitals are at risk of closing in the near future.

You'd expect that these closures would lead to more people going without hospital care,

and maybe also worse outcomes for patients in that region.

And that's exactly what a 2018 City Showed. It was published in the Journal of the American

Medical Association, and it looked at what happened when an obstetric unit closes in

a rural hospital. Three researchers found that those areas saw more babies born outside

of the hospital, or in hospitals without obstetric units, and more babies born early before

37 weeks. That paper was actually kind of one of the inspirations for our work.

Cory White is an economist at Monash University in Australia. He studies access to health care,

and he's been keeping an eye on rural hospital closures in the United States.

We thought there hasn't been a study that's looked at a really long time period and a wide

range of different outcomes, but there's this potentially really interesting trade-off

involved in these rural obstetric unit closures.

This interesting trade-off that Cory mentions is that not all rural hospital closures

are the same. Some closures could be bad, but others could have unexpected benefits for patients,

and might even improve the quality of their care.

But does that silver lining happen outside of obstetrics?

There are significant costs when a rural hospital closes and patients have to travel farther

for care, but of course that's not the whole story.

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