When Pickens County Medical Center closed weeks before the first wave of the COVID-19 pandemic, local pharmacies felt it immediately.

It’s one of many businesses in Carrollton, home to about 1,000 residents in western Alabama, that have had to lay off workers and cut expenses after the 56-bed hospital closed. Carrollton Drugs has a contract with the hospital to write prescriptions for about 200 employees at the facility.

Every business, from farming cooperatives to cafes, has been affected by the shutdown, said David Handley, who owns Carrollton Drugs and another pharmacy in Reform, Alabama.

“It’s been a huge financial and economic blow to this community,” said Handley, who served as director of pharmacy at Pickens County Medical Center for about 20 years. “The emotional toll is also huge. People worry because they don’t know what to do when a mum falls and breaks her hip, or someone has a stroke or a serious car accident.”

Pickens County is one of more than 100 rural communities that have seen their annual income, population and workforce decline following hospital closures, new research shows.

According to one data, the rural labor force shrank by 1.5 percent and the population size fell by 1.1 percent following the closure of potential payment-system hospitals. analyze It compared 109 rural counties with hospital closures and 1,650 rural counties with hospitals retained between 2001 and 2018. The study, published Monday in Health Services Research, found that hospitals switching to independent emergency departments or outpatient centers limited the economic impact.

“My co-authors and I believe that hospital remodeling should be viewed as an alternative to complete closures,” said study lead author Tyler Malone, a doctoral student in health policy and management at the University of North Carolina.

ninety-eight Rural hospitals across the country are closed Since 2005, according to UNC data. During this period, another 83 hospitals converted from inpatient care to outpatient and emergency services.

Pickens County Medical Center It was one of the most recently closed hospitals. In a press release issued when the hospital closed in March 2020, Pickens County Health Care said the hospital was unsustainable with too few patients, reduced federal funding and a growing number of uninsured patients.Hospitals tend to Financial performance is worse in states like Alabamadecided not to expand Medicaid.

“[Rural]hospitals are often the largest employers in the community — when a hospital closes, it’s a scary thing,” said Jeff Goldsmith, president of the consultancy Health Futures.

Without closing, rural hospitals had to open up certain services to stay afloat. From 2011 to 2019, nearly 200 rural hospitals stopped providing obstetric care, and from 2014 to 2020, nearly 300 rural hospitals stopped chemotherapy treatment, data Program from the Chartis Center for Rural Health.

As a result, residents have to travel farther to receive care, which has harm their health.

“I’m aware of two recent cases — a child and a teen trying to get to the DCH Regional Medical Center about 35 minutes from Tuscaloosa — but they were unsuccessful,” Handley said. “We now have an ambulance in the county, and if it’s on call or sitting in the DCH, families have to squeeze into their cars to get to the nearest medical facility.”

Research shows that rural hospital closures widen health inequalities.Rural counties who lost hospitals between 1990 and 2020 had higher proportions of Black and Hispanic residents, relative to the median for all rural counties Research Findings from the NC Rural Health Research Program published in March. Those counties were also more likely to have higher-than-median income inequality, lower per capita income and higher unemployment, according to the working papers.

According to Chattis, this trend partly explains why Black and Latino Americans living in rural areas are more likely to die prematurely or experience poverty, especially among children.

“If you lose a country hospital, you’re talking about tumbleweeds in the city centre. That means the high streets dry up and get blown away because affiliated healthcare services can’t survive very long without acute care support,” “National leader Michael Topchik said for Chattis. “Inaccessibility means delayed care, worse outcomes and more expensive acute care when things could have received more care locally.”

Rural hospitals are struggling Keep patients in their communities And avoid service line cuts.they have Partner with a neighboring academic medical center Try to maintain service through video consultation. Alternatively, more facilities are expected to be converted into stand-alone emergency departments or outpatient centers, which could provide a buffer to the local economy, policy experts said.

Operating costs, often subsidized by taxpayers, are reduced when hospitals stop inpatient care. As they focus on a more limited range of services, their quality may also improve, said Bai Ge, an accounting professor at Johns Hopkins University who has studied rural hospital closures.

“This shift makes hospitals financially healthier, better able to serve local communities and reduce taxpayer burdens, without harming the local economy,” she said.

Intensive and rural hospitals with fewer than 50 beds can be converted to new Current Situation of Emergency Hospitals in Rural AreasIt aims to boost rural hospitals with very low hospital admissions, which averaged about 38 percent in 2016, according to the data. modern medical research.

They will stop providing all inpatient care and will instead provide outpatient services, including 24/7 urgent care, observation, nursing facility services and ambulances. Beginning in 2023, these hospitals will have Medicare outpatient reimbursement rates 5% higher than full-service hospitals, in addition to monthly facility payments.

The study found that counties where rural hospitals converted inpatient surgeries to emergency, rehabilitation or outpatient services saw improvements in annual income and unemployment after the switch. The impact on population and labor force is negligible. But it remains to be seen whether these models will work in the long term, Topchik said.

Meanwhile, Carrollton residents like Debra Sudduth have had to deal with health emergencies without a local safety net.

Sudduth’s father has atrial fibrillation. His pulse dropped significantly Monday night, but the nearest hospital in Tuscaloosa, Mississippi, or Columbus was overwhelmed, she said. Fortunately, they were able to stabilize him at home and track his pulse with an oximeter, Sudduth said.

But last month, his ablation caused complications. His heart filled with blood and caused an infection. Without an ambulance, they had to drive about 45 minutes to get to Tuscaloosa Hospital, Sudduth said.

“He was fine in the end, but what if he didn’t? There’s a lot of older people here, driving for 45 minutes without an ambulance – it’s dangerous.”