As rural hospital closures become more common, many patients are left without sources of care, raising ethical questions about hospitals’ and clinicians’ responsibilities during and after closures.
In a new case study and commentary published online by the AMA Journal of Ethics, Dr. Mark Holmes, professor of health policy and management at the University of North Carolina Gillings School of Global Public Health and director of UNC’s Cecil G. Sheps Center for Health Services Research, and Ms. Sharita R. Thomas, research associate at the Sheps Center, explore this question.
“N Health Network recently announced the closure of one of its institutions, S Medical Center,” begins Dr. Holmes’ and Ms. Thomas’ case. “In a rural location, the medical center is the area’s only full-service, inpatient hospital, providing care to more than 20,000 residents since its opening 40 years ago. The medical center’s patients and staff of local clinicians will be consolidated and transitioned to N Health Network’s main campus about 30 miles away.”
In the related commentary, the co-authors report that the rate of hospitals closures nearly doubled from 7.5 per year 2010-2013 to almost 13 per year 2014-2018. They also offer the context that socioeconomic factors have been estimated to account for 47 percent of health outcomes, meaning poverty and inadequate transportation make rural residents particularly vulnerable to local hospital closures.
“People across the country are worried about rural hospital closures and what it would mean to their community if it happens,” Dr. Holmes said. “We wanted to explore the issue from an ethical perspective to inform how best to help communities adapt when they face a closure.”Friday Letter Submission, Publish on June 21