A new study published Thursday in the journal JAMA indicates that urban hospitals are closing at roughly the same rate as their rural counterparts, challenging the long-held assumption that hospital closures are primarily a rural crisis. Researchers from the Harvard T.H. Chan School of Public Health analyzed data on hospital openings and closures between 2010 and last year to determine trends in healthcare infrastructure across the United States.
The analysis found that urban hospitals experienced a closure rate of 9.1%, while rural hospitals saw an 8.3% closure rate over the same period. Overall, hospital closures increased by 4% year over year during the study window, while new hospital openings decreased by 3% annually. Between 2010 and 2025, a total of 432 hospitals closed, compared to only 216 that opened. This disparity resulted in a net loss of more than 24,000 hospital beds nationwide.
Closures Concentrated in Vulnerable Areas
The study identified specific characteristics associated with shuttered facilities. Hospitals serving communities with high poverty rates and limited transportation options were more likely to close. For-profit institutions, small hospitals, and safety-net facilities in vulnerable counties faced the highest risk of shutting down.
Geographically, the Midwest and the South recorded the most closures overall. The research also noted a correlation between Medicaid expansion and hospital viability, finding more closures in states that did not expand eligibility under the Affordable Care Act. Rural communities already contend with fewer doctors per capita and lower patient volumes, making them particularly susceptible to the loss of local medical facilities.
Of the hospitals that closed, approximately 73% shut down completely. The remaining facilities retained some level of service, primarily outpatient care, including rural emergency hospital services. New facilities that did open were predominantly urban, for-profit, and small in scale.
Federal Policy Shifts Impact Healthcare Funding
The findings emerge as federal healthcare funding faces significant restructuring. In July 2025, Congressional Republicans passed a broad tax and spending measure known as the One Big Beautiful Bill Act, which President Donald Trump signed into law. The legislation is projected to reduce federal Medicaid spending by an estimated $886.8 billion over the next decade, according to estimates from the Congressional Budget Office.
To offset potential impacts on underserved areas, the law includes $50 billion in rural health grants. These funds are scheduled to be distributed to states over a five-year period. The combination of reduced Medicaid spending and targeted grant funding represents a major shift in how federal resources support healthcare infrastructure, particularly in regions already experiencing high closure rates.
While rural areas have historically drawn attention for their healthcare deserts, urban facilities are not immune to financial strain. The data suggests that poverty levels and transportation access are critical factors in hospital survival, regardless of whether a facility is located in a city or the countryside.