News & Analysis

Saving Rural Healthcare Access: Three Core Recommendations

Portrait of Dawn Carter

Dawn Carter

A white H against a field of blue

All too often these days, another rural hospital announces its closure. Even more disheartening than losing the blue “H” sign is that many of these communities lose access to healthcare. According to data from the Sheps Center, more than 100 rural hospitals have closed since 2010, and 60% of these communities have no rural healthcare access, including no emergency or outpatient care.

These communities are not all the same. Some are located in counties as small as 5,000 residents, but others are located in areas with nearly half a million residents. Some are a considerable distance from any other healthcare service, while others can find services less than 30 minutes away. These communities may face significant health issues or they may have relatively healthy populations.

The bottom line is that while there is no one solution to solving the plight of rural healthcare, here are three core recommendations for transforming rural healthcare.


Over the average American’s lifetime, they will be admitted to a hospital fewer than 10 times, but they will see a primary care physician 120 times. Maintaining a vibrant primary care base is critical to ensuring rural healthcare access, yet it often does not get the attention it deserves. The numbers alone tell us that maintaining vibrant primary care has the greatest impact on day-to-day health.

As difficult as it is to recruit primary care physicians to rural communities, Primary Care Done Right suggests that we focus on advanced practice providers to fill that gap, along with educators, dieticians, social workers, and others who make up a comprehensive care team. The beauty of a primary care strategy is that it benefits under today’s fee-for-service system by generating specialty and other referrals and also establishes the core of the future delivery system in a transformed environment.


At a closure rate of 15 [1] hospitals per year since 2013, the traditional model for rural healthcare clearly is not sustainable. Finding a sustainable solution will vary depending on the unique circumstances of each community. For example, are inpatient services sustainable in a transformed environment? For some, this answer will be yes, but for others, our HealthytownTM model shows that the reduction in admissions resulting from transformation will make inpatient care no longer sustainable. Critical to sustainability is a shift in thinking from “How do we save our hospital?” to “How do we maximize rural healthcare access in our community?” All too often, rural communities have sacrificed their financial ability to sustain robust access points in a doomed effort to hold on to their traditional hospital.


What are the greatest health needs of the population you serve? Are those services sustainable at current or transformed volumes? If not, how do you deliver access to those services? What are the core medical services that your community can sustain? Without getting too far ahead of payment changes, what nontraditional, population health-based services would have the most impact on your community? Which of those nontraditional services are affordable and can be wrapped around core medical services as you begin to transform to a new model of care?

The rural regions of our country are vital for our own sustainability. [2] They provide our food, educate our children, and make and sell goods. While the traditional rural hospital may be dying, we must work aggressively to save rural healthcare.