Summary: GAO discussed: (1) the impact of rural hospital closures on medical care accessability; (2) the factors that increase the risk of rural hospital closures; and (3) federal, state, and local efforts to address the viability of rural hospitals. GAO noted that: (1) although most closures did not significantly reduce access to care, about one-third of the 1986 rural closures may have either created or worsened access problems for low-income residents and patients needing emergency care; (2) rural hospitals were vulnerable to closure since, as a group, they had such characteristics associated with the risk of closure as small size, low occupancy, and competition from private hospitals; (3) closed rural hospitals had limited economic impact on the surrounding community, since those hospitals did not provide an abundance of jobs; (4) some federal assistance efforts provided financial relief to certain subgroups of rural hospitals, but did not systematically maintain access to hospital care; and (5) although the Rural Health Care Transition Grant Program is potentially the best program available to address hospitals' underlying operational problems, the government needs to strengthen the program's assistance policies to target such problems before closure becomes necessary.
