On the closure of a rural(ish) hospital in California's Central Valley

I've been thinking about the hospital closure in Madera County, California, since it happened earlier this year, leaving this entire county without a hospital.  Now, two Los Angeles Times reporters and a photographer have done a deep dive into the consequences of the January closure of the Madera Community Hospital.  (Here are all of the posts that have mentioned Madera County over the years).  Here's an excerpt highlighting the gist of what has happened in Madera County--and what is threatening other rural hospitals: 

During its half-century run, Madera Community Hospital provided a crucial link to healthcare for the 160,000 people who call Madera County home. Spanning from the heavily farmed floor of the eastern San Joaquin Valley to the forested central Sierra, Madera is majority Latino, and 20% of the population live in poverty.

For most residents, the hospital was more than a place to go when disaster struck. Madera Community helped them sign up for Medi-Cal, the state’s version of Medicaid insurance for low-income adults and children. It was readily accessible by bus, and it coordinated services with community clinics where residents could receive routine care and prescriptions. Sometimes the hospital was the only place people saw a doctor. Unlike the many private providers that exclude certain types of health insurance — including Medi-Cal, with its notoriously low reimbursement rates — Madera Community served everyone.

“It’s the worst thing that could have happened to us,” Tony Camarena said of the closure. Camarena runs a business that enables sending money abroad, and many of his customers made use of the hospital’s services, he said.

Healthcare experts say Madera’s closure — and the untenable financial realities that brought on the collapse — offer a case study on the challenges facing rural hospitals across the country. Nearly 30% of all rural hospitals in the U.S. — more than 600 of them — are at risk of closing, according to the Center for Healthcare Quality and Payment Reform.

In California, nine rural hospitals have been shuttered since 2005, and 17 are at risk of closing. Kaweah Health Medical Center in Visalia, about an hour’s drive from Madera and the largest hospital in rural Tulare County, is among those bowing under serious financial problems.

Experts in healthcare economics say rural counties generally have fewer patients than suburban and urban communities — and a high share of those patients are low-income and enrolled in Medi-Cal. That means there are fewer patients with private insurance whose payments can offset Medi-Cal’s low reimbursement rates. Small hospitals also have less muscle than bigger ones to negotiate rates from private insurance companies.

Don't miss the rest of this engaging and deeply reported story.