Coronavirus in rural America (Part XXXI): Big NYT feature on rural hospitals, closures

On the home page of the New York Times since this morning has been this cool map showing where Americans live in proximity to an emergency room.  I note that most of the folks spatially removed from an ED (emergency department) are in the west--not surprising given the greater population sparseness there.  But in my home state of Arkansas, the places where people tend to be that far from an ED include, yes, my home county, Newton County, Arkansas.  I know from first hand experience that the nearest ED is the hospital where I was born, at that time the Boone County Hospital, now the North Arkansas Medical Center.  Other places in Arkansas that are what we might consider health care deserts are west central Arkansas and a few places in the Mississippi River Delta.

The complementary feature to the map is this very long and deeply reported New York Times story on what is happening in rural America in relation to the coronavirus crisis.  It focuses on recent rural hospital closures, which number 120 in the past decade.  Some of those closures are attributable to consolidation, some in Appalachia (as previously reported).  Here are a couple of data intensive paragraphs from the story:

Across the United States, hospitals serving rural areas have spent decades trying to provide medical care and produce enough revenue to stay open. They have closed in increasing numbers in recent years as local populations have declined. About 170 rural hospitals have shut down since 2005.

* * *  

But for-profit hospitals are more likely to close than the others, one recent federal study showed. It found that for-profit facilities accounted for 11 percent of rural hospitals but 36 percent of closures among the group. Within the past year, rural hospitals have closed in Pennsylvania and Tennessee after selling to for-profit chains.

The story mentions the work of Jill Horwitz, Vice Dean of the UCLA School of Law, who studies hospital ownership and consolidation.  She has found that "for-profit rural hospitals were less likely to offer needed but unprofitable medical services, such as hospice and inpatient psychiatric care."  Here's a quote form Horwitz:

There is something very concerning to me about having more for-profit companies in rural health care. The more rural a hospital, the more people depend on it for lifesaving care.

* * * 

The goal of the for-profit is to make money. That doesn’t mean they’ll do anything to make a buck, but they have a different goal from nonprofits.

I'm glad to know that a very urban scholar in a city like Los Angeles is expressing concern about what is happening in rural America.  It reminds me of this recent scholarly article by Elizabeth Weeks. 

Here's an excerpt about Early County, Georgia, in the state's southwest corner, where five of the county's 11,000 residents have died, and 92 cases of coronavirus have been reported.  The mayor and police chief of the small town of Blakely are among those infected.  Here's a quote from the assistant police chief, Tonya Tinsley, that is heavy on small town lack of anonymity. 

Being from a small town, you think it’s not going to touch us.  We are so small and tucked away. You have a perception that it’s in bigger cities. 

That is all gone now. 

You say, wait a minute, I know them!. It’s, like, oh my God, I knew them. I used to talk to them. I knew their family. Their kids. It’s a blow to the community each time.

This comprehensive story mentions many U.S. regions and quotes Montana Senator Jon Tester about the situation in his state.  It's well worth a read in its entirety.