Structural issues threaten California's rural hospitals

Scott Wilson writing in the Washington Post last fall provided a deep dive into why California's rural hospitals are faltering.  The dateline is Madera, California, and the headline is, "A hospital’s abrupt closure means, for many, help is distant."  

Here's some detail about the Madera closure (topic of this earlier post) and what it portends for other hospitals in rural California:

The shuttering of the 106-bed hospital here, which has disrupted health-care services across this region of vast almond groves and grape orchards, is the first of what state lawmakers say could be more shuttered rural hospitals.

And here's some structural analysis about why this is happening, which I've not yet seen elsewhere.  

California’s rural health-care system is teetering, a consequence of the pandemic’s long legacy, a broadly unhealthy patient pool due to higher poverty rates, and the imbalances in the way a rich state focuses its public health resources.

The dilemma exposes California’s widening east-west divide, a rural-urban split that helps define how the state government distributes resources for public health programs, education and other basic services. The eastern valleys and Sierra foothills, less populous and generally more conservative in their politics, have often been neglected by liberals from the coastal West.

In this case, the inequality comes in the form of often-inadequate government insurance reimbursements for rural hospitals, especially community hospitals unaffiliated with large health networks, and in medical education opportunities, which are scant to nonexistent across much of the Sierra Nevada and Central Valley.

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Across a state with the highest proportion of millionaires in the nation, 1 in 5 hospitals are now at risk of closing, according to a study released earlier this year by the California Hospital Association. Many serve the state’s rural redoubts, whose populations are often disproportionately poor and underinsured, and inner-city neighborhoods such as south-central Los Angeles.

Wilson quotes Carmela Coyle, chief executive of the California Hospital Association, a lobbying group that represents some 400 hospitals:  

We find ourselves at a time in health care, and for hospitals in particular, where finances are very fragile.  Like a family living paycheck to paycheck, that works until there is a financial shock. That’s what our hospitals face today — and the pandemic was that shock. They spent everything and now have nothing to fall back on.