Study details and key findings

For the study, researchers from the Harvard T.H. Chan School of Public Health created a national dataset of acute care hospitals using data from the American Hospital Association's annual survey and tracked every closure and opening. A hospital was considered closed if it stopped offering inpatient care. Nonacute, federally owned, and Indian Health Services hospitals were not included in the study.

Of the 4,962 hospitals included in the study, 432 (8.7%) closed and 216 (4.4%) opened between 2010 and 2025. By 2025, the United States had 216 fewer hospitals and 24,399 fewer beds. Among the hospitals that closed, 315 shut down completely while 117, including 45 rural emergency hospitals, continued to provide outpatient care.

Year over year, the rate of hospital closures increased by 4% while the rate of openings decreased by 3%. According to the researchers, the hospitals that closed were more likely to be smaller, for-profit, and safety-net hospitals, which typically provide care for more vulnerable communities and uninsured patients. Closure rates were largely similar for both urban (9.1%) and rural (8.3%) hospitals.

Hospital closures in rural areas often forced residents to travel farther to reach the next-nearest hospital. If all the rural hospitals that had closed reopened, the median distance to the next-nearest hospital could be reduced from 17.6 kilometers to 10.1 kilometers.

Most of the newly opened hospitals were urban, for-profit, and smaller hospitals. Newly opened hospitals were "rarely" safety net hospitals or those that served a higher proportion of Medicaid patients, the researchers said.

"Many policymakers have been treating hospital closures as a rural problem, but our data show it's a national problem," said Thomas Tsai, an associate professor of health policy and management at Harvard T.H. Chan and one of the study's authors. "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?" 

Commentary

In addition, Tsai noted that hospital closures will negatively impact more than just hospitals themselves. As more hospitals close, patients will see longer wait times as they're transferred to other facilities, and primary care will be affected as surgeons and other specialists lose their workplaces.

"It creates a massive domino effect," Tsai said.

With the threat of hospital closures and their negative effects growing, Pace urged healthcare stakeholders, as well as community and government leaders at all levels, to work together to develop an effective response.

"The needs of the Medicaid population are well known, as are the solutions; there are few mysteries here," Pace said. "What's missing is political courage and funding, and if those two aren't present, the pain will be swift and substantial, overburdening the entire healthcare system. We have had years to prepare for this, and yet here we are in a fully defensive posture, scrambling to figure out what to do. Perhaps the urgency will yield solutions."

*Advisory Board is a subsidiary of Optum. All Advisory Board research, expert perspectives, and recommendations remain independent.