Rural hospital closures drive up surgical travel times and costs

Editor's Note

Ongoing hospital closures are driving up travel times and out-of-pocket costs for rural Americans who need surgery, according to a February 12 report in HealthDay.

Citing two recent studies published in Annals of Surgery and JAMA, respectively, the article details how rural hospital closures have forced more patients to travel an hour or more for surgical procedures. By 2020, 44% of rural patients had to drive at least an hour for surgery—up from 37% a decade earlier. On average, rural Americans traveled 55 minutes to reach a surgical center.

For many of these Americans, distance is not the only barrier, HealthDay reports. Even for insured patients, rising out-of-pocket costs are limiting access, particularly with the rise of high-deductible insurance plans. Dr Cody Mullens, a surgical resident at Michigan Medicine and the lead author of both studies, told the outlet that many struggle with underinsurance in the wake of a significant reduction in uninsured patients due to the Affordable Care Act. When high costs and difficult travel logistics delay surgery, conditions worsen and surgical complexity increases, he added.

The Annals of Surgery study examined surgical care access from 2011 to 2020 using Medicare, Medicaid, and hospital association data. Researchers defined adequate access as living within an hour of a three-star-rated hospital and being able to afford the procedure after insurance adjustments. They found that nearly 7% of rural patients had insufficient access, compared to 2% of urban residents. 

The JAMA study analyzed travel times for 16 types of surgeries, ranging from low-risk procedures like hernia repair and joint replacements to more complex operations. Researchers pointed to healthcare policies that have centralized surgeries at high-quality hospitals. While this approach improves outcomes for complex cases, Mullens argues that many routine surgeries can be safely performed at rural hospitals. 

As a potential solution, study authors suggest increasing telehealth visits for preoperative consultations to minimize travel burdens, HealthDay reports. Patients, particularly those anticipating surgery, should also consider insurance options beyond monthly premiums, such as deductible levels and savings accounts, to reduce financial strain.