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A Harvard-led study found that U.S. hospitals closed faster than they opened from 2010 to 2025, producing a net loss of 216 hospitals and more than 24,000 beds. Closure rates did not differ significantly between rural and urban areas, while closures were more common among hospitals serving socially vulnerable communities.
A Harvard-led study published October 8 in JAMA found that U.S. hospitals closed faster than they opened from 2010 through 2025, resulting in a net loss of 216 hospitals and more than 24,000 beds. The researchers found no significant difference in closure rates between rural and urban areas, while hospitals serving socially vulnerable communities were more likely to close.
The researchers analyzed American Hospital Association annual survey data on hospital openings and closures over the 15-year period. They counted 432 hospital closures and 216 openings. The study also reported that closures increased by 4% year over year and openings decreased by 3% year over year; the supplied report does not specify the precise calculation behind those annual change figures.
Closures were more common among for-profit, small and safety-net hospitals, as well as hospitals located in counties with the highest levels of social vulnerability. These patterns appeared in both rural and urban communities. By contrast, safety-net hospitals and hospitals serving many Medicaid patients rarely opened, according to the study.
The research letter, titled Longitudinal Trends and Characteristics of Hospital Closures and Openings, was led by J. E. Calianos and colleagues. Thomas Tsai, the corresponding author, is an associate professor of health policy and management at Harvard T.H. Chan School of Public Health and co-director of its Healthcare Quality and Outcomes Lab.
Closures Affect Vulnerable Communities
The findings challenge the tendency to treat hospital closures as a rural-only concern. Similar closure rates in rural and urban areas suggest that access risks extend across the country, even though the local effects may differ depending on the availability of other hospitals and transportation.
The study’s reported pattern also points to a distributional concern: small and safety-net hospitals, which often serve communities with fewer resources, were among those more likely to close. A decline in hospital beds can reduce local capacity for inpatient care. The research does not measure how individual closures affected patients or whether nearby facilities absorbed their care, so the scale of those effects cannot be determined from the reported totals alone.
The findings arrive as hospitals and policymakers face concern about future financing. The source report says changes to Medicaid policy in the One Big Beautiful Bill Act have led hospitals to anticipate the loss of billions of dollars in funding. The study tracks closures through 2025, however, and does not establish that the law or its Medicaid changes caused the closures it counted.
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A National Debate on Hospital Access
Policy attention to hospital closures has often focused on rural communities. The source report says Congress created the Rural Health Transformation Program, which provides billions in state grants for rural hospitals, amid concern about their financial stability. Before this study, the report says, whether closures were concentrated in rural areas had been little studied and remained largely unknown.
The new analysis examines openings as well as closures, providing a national count across rural and urban settings. Its 2010–2025 period offers a longer view than a snapshot of current hospital finances, but it ends before the full effects of recent Medicaid policy changes can be assessed. The study therefore describes past trends; it is not a forecast of how many hospitals may close in the coming years.
“Many policymakers have been treating hospital closures as a rural problem, but our data show it’s a national problem.”
— Thomas Tsai, corresponding author and Harvard T.H. Chan School of Public Health associate professor
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What the Study Does Not Establish
The study reports similar rural and urban closure rates, but the supplied findings do not provide the exact rates, the statistical estimates, or details about how the researchers classified rural and urban hospitals. They also do not quantify how many patients lost nearby access to care or whether other hospitals took on that demand.
The results show which types of hospitals were more likely to close, but they do not establish why each hospital shut down. In particular, the analysis period ends in 2025, so it cannot show whether later Medicaid policy changes contributed to subsequent closures. The report also gives no projected closure count or estimate of future bed losses.
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Monitoring Access and Future Closures
The published research letter gives policymakers a national baseline for tracking hospital openings, closures and bed capacity across rural and urban areas. Future data will be needed to determine whether the reported trends continue and how recent funding and policy changes affect hospitals, particularly those serving Medicaid patients and socially vulnerable communities.
The supplied report does not identify a scheduled follow-up study or a specific next policy action. For now, the key unanswered question is whether programs focused on rural facilities, alongside broader financing decisions, will protect access in vulnerable communities in both settings.
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Key Questions
How many U.S. hospitals closed from 2010 to 2025?
The study counted 432 closures and 216 openings during that period, a net loss of 216 hospitals.
Were rural hospitals more likely to close than urban hospitals?
The researchers found no significant difference in closure rates between rural and urban hospitals. The supplied report does not give the exact rates.
Which hospitals were more likely to close?
Closures were more common among for-profit, small and safety-net hospitals, and hospitals in the most socially vulnerable counties, in both rural and urban areas.
Did Medicaid policy changes cause the closures?
The study covers closures and openings from 2010 through 2025 and does not establish that later Medicaid policy changes caused those closures. The report says hospitals have raised concerns about potential funding losses, but that is separate from the study’s findings.
How many hospital beds were lost?
The study reported a net loss of more than 24,000 beds alongside the net loss of 216 hospitals between 2010 and 2025.
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