Rural Hospitals Are Closing. Americans Are Losing Access To Health Care

Dec 10, 2019

The impossible cost of health care in Appalachia: $40,000 for a single ambulance ride. We take a look at the cost of health care consolidation in rural America.


Mason Adams, freelance reporter who has been covering Appalachia since 2001. Author of “$44,000 for an Ambulance, Hour-Long Drives to an ER: The Impossible Cost of Healthcare in Appalachia.” (@MasonAtoms)

Tony Keck, executive vice president for System Innovation and chief population health officer at Ballad Health. (@tonykeck)

Thomas Ricketts, senior policy fellow at the  Cecil G. Sheps Center for Health Services Research. Adjunct professor of health policy and management and social medicine at the UNC-Gillings School of Global Public Health and the UNC School of Medicine. Founding director of the North Carolina Rural Health Research Center. (@ThomasCRicketts)

From The Reading List

In These Times: “$44,000 for an Ambulance, Hour-Long Drives to an ER: The Impossible Cost of Healthcare in Appalachia” — “When Heather Edwards’ contractions began three months early, in March, she worried about the long drive to the hospital from her home nestled in the Appalachian Mountains in Jonesville, Va., a town of fewer than 1,000 people. Edwards, 32, was carrying quadruplets and hers was considered a high-risk pregnancy. The nearest hospital with a neonatal intensive care unit (NICU) was an hour away in Kingsport, Tenn., Holston Valley Medical Center.

“A decade ago she could have found an emergency room, if not a NICU, 10 minutes up the road at Lee County Regional Medical Center in Pennington Gap, Va., but the hospital closed in 2013 due to low community use, a lack of local physicians and Virginia’s refusal to expand Medicaid, which left the state’s rural hospitals to provide uncompensated care to uninsured patients. In 2012, the Lee County hospital was nearly $2.5 million in the red.

“Neighboring counties do have emergency rooms, but none offered the NICU care Edwards needed. She decided to make the 44-mile drive along twisty mountain roads to Holston Valley Medical Center.

“‘If I went to [a different hospital], they were just going to fly me to Holston Valley or the [next] closest NICU,’ Edwards says. ‘It would have been a waste of time.’

“Edwards barely made it. Moments after she arrived, ‘everything just broke loose, and I went into labor,’ Edwards says. ‘They tried to stop it and couldn’t. I had an emergency C-section.’

“Edwards considers herself lucky. For the residents of rural Appalachia, long drives for emergency care are often a matter of life and death.”

West Virginia Public Radio: “The High Cost Of Living Rural: A Q&A With A Journalist Covering Healthcare In Appalachia” — “Rural hospitals across the country are closing in large numbers, making emergency and speciality services harder and harder to come by for Americans who don’t live in urban centers. One hundred and thirteen rural hospitals have closed since 2010, and about a third of the remaining, some 670, were at risk of closing in 2016.

“Mason Adams, who is based in Floyd County, Virginia, detailed the impacts of those closures on rural Appalachians in his latest report for In These Times. That includes the increased travel times that many older, poorer Appalachians now face to reach the medical services they need, sometimes requiring helicopter rides in emergency situations that can cost upwards of more than $44,000, more than the average annual income in many of the communities directly effected.

“Adams also details the difficulty communities face in finding adequate services after their local facilities downgrade the services they offer after consolidations in rural healthcare systems, such as trauma care and neonatal intensive care units (NICUs), all of which contribute to the growing cost of rural health care.”

Minnesota Public Radio: “Mayo closes two more facilities, blames rural health care crisis” — “Mayo Clinic on Wednesday announced it will close facilities in Springfield and Lamberton in southwestern Minnesota early next year, continuing a trend of closures and service cuts in rural areas.

“Mayo Clinic has closed or consolidated at least 16 facilities in southern Minnesota, Wisconsin and Iowa since 2009, reflecting what Mayo says are mounting demographic and financial pressures facing rural health care.

“The latest announcement involves a clinic in Lamberton and a hospital and clinic in Springfield. Mayo officials say the closures, slated for March 2020, will affect 60 people working in these southern Minnesota facilities.”

CNBC: “Opinion: Heidi Heitkamp: America’s rural health care crisis must be addressed” — “When it comes to health care, America’s political leaders have shown they are lousy at triage. Republicans and some Democrats continue to push policies that would either take health insurance away from millions or dismantle the private insurance system entirely – acting like two doctors bickering over the long-term treatment for a patient with a chronic condition. Meanwhile they are neglecting a patient in dire need of emergency care – the rural health system.

“This crisis is years in the making and increasingly getting worse. A confluence of issues including rural hospital closures and a growing physician shortage, are wreaking havoc not only on rural patients’ access to quality health care, but the economic well-being of their communities.

“For some politicians in Washington, Medicaid expansion and hospital infrastructure are not flashy enough topics to mention on cable news or in a rousing floor speech. But these are the issues that need to be talked about if we are going to address the fact that of surveyed adults living in rural areas, 26 percent lacked access to health care when they needed it.”

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