As rural hospitals have closed or shuttered essential services in recent years, health centers have stepped up to fill gaps in communities’ healthcare systems and mitigate some of the negative effects of closures on health outcomes.
Health centers are essential primary care providers in rural communities across the country. According to HRSA’s Uniform Data System, 595 rural health centers operated 6,397 sites across rural America. Together, they served nearly 10 million individuals (about one in five rural residents) through over 36 million clinical visits and over 3 million virtual visits. In many rural communities, health centers are the only care providers available, as hospitals and other providers can be many miles away.
Abrupt hospital closures in rural areas have reached crisis proportions and strained health centers’ ability to absorb and adapt to the number and needs of patients left without care. According to the Cecil B. Sheps Center for Health Services Research at the University of North Carolina, in 2013, 2,322 rural hospitals were serving 20 percent of Americans, around 60 million people. Since 2010, 86 of these rural hospitals have closed and 64 have ceased to provide inpatient services. The problem is getting worse – a recent study found that 700 rural hospitals are at risk of closing due to financial losses.
In 2023, NACHC found that 100 million Americans lack access to primary care, and the number lacking access due to an inadequate supply in their local community has nearly doubled since 2014. In many rural communities, hospitals’ emergency departments are significant providers of primary care, and closures exacerbate existing gaps in access to emergency and specialist services as well as primary and preventive care. Health centers’ governance model of patient majority boards means they are well-positioned to respond to the communities’ needs when a hospital closes.
In 2020, Capital Link conducted a survey assessing how rural health centers respond to rural hospital closures. They found that health centers preserved the communities’ access to key services by acquiring buildings or facilities, assuming services, and ramping up partnerships and collaborations. Of the CHCs that have collaborated to retain access to services, the most prevalent have been primary care, prenatal services, and mental health/behavioral health/substance use disorder services.
Health Centers Fill Gaps in Access to Healthcare
Protecting Access to Maternal Healthcare
Health centers are important providers of maternal health care, and that is especially true after a hospital closure. Health centers fight maternal mortality after hospitals close or shutter by ramping up testing, medication management, follow-up appointments, and consultations with specialists in the field.
In North Carolina, the Betsy Johnson Hospital in Harnett County closed its labor and delivery ward. Since then, CommWell Health has been working to expand its prenatal care services as they have seen an influx of pregnant patients in need of care. While they currently have two OB/GYNs on contract for two half-days a week due to the prohibitive cost, they are working to expand and preserve prenatal care in the community to support healthy pregnancies and births.
In California’s Central Valley, the closure of Madera County Hospital put significant pressure on Camarena Health, the local Community Health Center. The hospital closure left hundreds of mothers without access to essential maternal diabetes care, placing them at risk for pregnancy complications and adverse neonatal development. Faced with this lack of access, Camarena Health was able to develop an internal program to replicate all the same services previously provided by the hospital, including testing, medication management, follow-up appointments, and consultations with specialists in the field. This has created convenience for patients to remain within their medical home to receive gestational diabetes counseling and management, including dietary instruction and medication prescriptions.
Expanding Service Locations to Protect Access to Care
In response to hospital closures, some Community Health Centers have preserved services by acquiring buildings or facilities previously owned by hospitals. In response to a hospital closure, the NorthLakes Community Clinic opened a new clinic in Eau Claire, WI, to provide medical, dental, behavioral health, and substance use disorder services to patients left without a provider. This new clinic expanded care provided in the Chippewa Valley.
Mercy Hospital in Fort Scott closed in 2018, leaving the town of 7,800 with no hospital within thirty miles. Community Health Center of Southeast Kansas (CHC/SEK) stepped in to help by acquiring four medical practices that had been part of the hospital and setting up a clinic site in a building that had previously housed the hospital. They hired many of the hospital staff to keep providers in the area and set up new models of care that many say resulted in better care than patients had received before the hospital closed.
Protecting Jobs and Boosting Rural Economies
Health centers are significant sources of economic development in rural communities, creating good-paying jobs and offering rewarding career paths in primary care. More than 80 percent of rural health centers also serve as training site partners and sponsors, enabling the next generation of care providers to understand rural communities’ unique challenges. In 2023, rural Community Health Centers trained more than 3,000 physicians, including 100 OB/GYNs. Health centers also offered opportunities to individuals without a traditional educational background, training over 2,000 Registered Nurses and more than 1,500 Medical Assistants in 2023.
For example, in Williamston, NC, Agape Health Services, preserved access to care after the closure of Martin General Hospital by reopening an orthopedic clinic previously managed by the hospital. Additionally, Agape Health Services absorbed a Nurse Practitioner and her team when their primary care clinic closed, keeping providers in the community and preserving their community partnerships.
Community Health Centers are essential providers in rural communities across the country and serve many of the same communities that rural hospitals do. As aging demographics and economic challenges put pressure on rural health care delivery systems, health centers have stepped up to meet their communities’ needs by meeting maternal health challenges, protecting health care jobs, and broadening their service offerings to fill gaps in care.