What is a closed hospital?

We follow the convention of the Office of Inspector General that a closed hospital is “A facility that stopped providing general, short-term, acute inpatient care [….]” We did not consider a hospital closed if it: Merged with, or was sold to, another hospital but the physical plant continued to provide inpatient acute care, Converted to a Critical Access Hospital, Converted to a Rural Emergency Hospital, or Both closed and reopened during the same calendar year and at the same physical location.

A facility that no longer provides health services is considered a “complete closure.” Note that a facility that closed its inpatient unit but continued to provide other health services, like urgent or emergent care services, rehabilitation, and/or outpatient services, at the same physical location would be considered a “converted closure“. Likewise, a facility that dramatically scaled back its inpatient services (e.g., from 70 beds to 2 beds) would be considered “open” because it continues to provide inpatient services (albeit in a vastly reduced manner).

A conversion to a rural emergency hospital is not considered a closure. Rural Emergency Hospitals Map

In some instances, a hospital closes but reopens in another location. In these circumstances, we use our best judgment as to whether access to inpatient services in the rural community was considerably affected by the move to the new location. A move across town or outside city limits would generally not be considered a “closure”; reopening in a community 10-15 miles away, however, likely would.

Make sure to see our FAQ below for additional information.

Rural Hospital Closures 2005-Current

Do you know of a hospital that closed within the past 10 years that is not on our list? Do you know of a hospital that is on the brink of closure? Please complete an inquiry below or email your information and tips to us here: ncrural@unc.edu

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What is a rural hospital?

• A Critical Access Hospital, or
• A Rural Emergency Hospital, or
• Any short-term, general acute, non-federal hospital that is located in:
  1. any non-metro county,
  2. metro census tracts with RUCA codes 4-10, or
  3. large area Metro census tracts of at least 400 sq. miles in area with population density of 35 or less per sq. mile with RUCA codes 2-3.
  4. Beginning with Fiscal Year 2022 Rural Health Grants, we consider all outlying metro counties without a Urbanized Area to be rural.

Additional information is available at Federal Office of Rural Health Policy, Defining Rural Population.

What is a complete closure?

A complete closure occurs when a rural hospital ceases to provide any health care services.

What is a converted closure?

A converted closure occurs when a rural hospital ceases to provide inpatient services, but continues to provide some health care services such as primary care, skilled nursing care, or long-term care.

What about a hospital that closes in one location and moves to another location?

We judge whether access to inpatient services in the rural community was considerably affected by the move to the new location. A hospital that moves across town or just outside city limits would probably not be considered a closure.  A hospital that moves 10-15 miles away would probably be considered a closure.

What about a hospital that closes but reopens months or years later?

When a closed hospital reopens and resumes provision of inpatient services, it is removed from our list of closed hospitals.

Is conversion to a Rural Emergency Hospital (REH) considered a closure?

No, a Rural Emergency Hospital is a separate type of hospital. A list of current Rural Emergency Hospitals is located here: Rural Emergency Hospitals Map.

How are closures identified?

We collect information from websites, news alerts, analyses of Centers for Medicare & Medicaid Services data, and information exchange with the Federal Office of Rural Health Policy, the National Rural Health Association, the American Hospital Association, and the public.

What recent research has the NC Rural Health Research Program published about rural hospital closures?

1. Khushalani JS, Holmes M, Song S, Arifkhanova A, Randolph R, Thomas S, Hall DM. Impact of rural hospital closures on hospitalizations and associated outcomes for ambulatory and emergency care sensitive conditions. J Rural Health. 2022 May 5. doi: 10.1111/jrh.12671.
2. Malone, TL, Planey AM, Bozovich LB, Thompson KW, Pink GH, Holmes GM. The economic effects of rural hospital closures, Health Services Research, March 21, 2022. https://doi.org/10.1111/1475-6773.13965.
3. Planey AM, Perry JR, Kent EE, Thomas SR, Friedman H, Randolph RK, Holmes GM. Since 1990, Rural Hospital Closures Have Increasingly Occurred in Counties that Are More Urbanized, Diverse, and Economically Unequal. NC Rural Health Research Program. UNC Sheps Center. March 2022. FB 171.
4. Osgood AS, Pink G. Rural Hospitals that Closed between 2017‐20: Profitability and Liquidity in the Year Before Closure. NC Rural Health Research Program. UNC Sheps Center. January 2022. FB 170.