Surgical Hospital Closures Deepen Health Care Access Gaps
New ACS findings show that surgical hospital closures have been concentrated in high-poverty, high-vulnerability communities. Harvard Chan School’s Leadership Development to Improve Health Outcomes for All program is designed to help health care leaders respond with context, coordination, and an equity lens.
When a surgical hospital closes, the consequences travel fast.
Patients may have to drive farther for care. Some delay treatment. Others seek help at lower-acuity facilities that are closer to home, only to face transfer delays when they need surgery or specialty services. In rural communities, those added miles can mean an hour or more in transit—and another barrier layered onto existing inequities.
New research on surgical hospital closures underscores how unevenly those burdens are falling. Between 2010 and 2020, the U.S. saw a net loss of 298 hospitals capable of performing surgery. Closures were disproportionately concentrated in communities with higher poverty and higher social vulnerability, and the number of geographic areas within a 15-minute drive of a surgical hospital dropped by 6.2%.
For Mary Fleming, program director of Harvard T.H. Chan School of Public Health Executive Education’s Leadership Development to Improve Health Outcomes for All, those findings point to an urgent equity challenge that is both immediate and structural.
“As one could assume, a decrease in surgical hospitals decreases access, increases barriers and has a negative impact on outcomes,” Fleming said.
She notes that when patients must travel farther for care, some may forgo care altogether. Others may arrive first at facilities not equipped to provide the level of treatment they need, creating additional burdens on transfer systems and delaying care. Receiving hospitals, in turn, can become overwhelmed, contributing to workforce strain, suboptimal care, and provider burnout.
How Surgical Hospital Closures Affect Vulnerable Communities
Fleming argues that hospital closures cannot be understood only as isolated operational failures. They must also be seen in historical and policy context.
“This program helps participants understand the historical factors that influenced where hospitals were built, who they serve and the financial considerations that may lead to hospital closures,” she said. “Understanding the context will then allow the participants to have insights on both supporting the community in real-time, influencing other leaders to understand why the closure happened and hopefully preventing future ones.”
That perspective aligns closely with the goals of the Harvard Chan School program. Leadership Development to Improve Health Outcomes for All is built to help participants examine how racism, unconscious assumptions, structural faults in the health care system, and avoidable differences in the drivers of health shape outcomes. The program also emphasizes equity-centered communication, data-informed decision-making, change management, and strategies for centering the needs of populations made most vulnerable.
In practice, that means helping leaders look beyond the immediate crisis and ask harder questions: Why was this community more exposed to closure risk in the first place? Which policies and incentives shaped that vulnerability? And what would it take not just to absorb the loss, but to prevent the next one?
What Leaders Should do First
For Fleming, reimbursement policy is one of the most important levers.
“The U.S. healthcare reimbursement policies greatly influence our care-delivery system,” she said. “Areas with higher Medicaid populations and lower reimbursement rates can influence a hospital’s ability to keep their doors open.”
That is why she hopes program participants leave with more than awareness. They need examples of best practices, opportunities to innovate, and the leadership skills to build capacity within strained systems. Just as important, she said, they need to be able to help others understand why improving health for the most vulnerable strengthens the health of the entire community.
In communities affected by surgical hospital closures, some of the first steps may be practical rather than grand: strengthen referral pathways, clarify where patients should go for what level of care, and ensure that access problems do not become communication failures as well.
Protecting Maternal and Surgical Access
Fleming, who has led maternal health innovation and continues to practice as an OB/GYN, sees telehealth and mobile health as among the most immediate ways to extend access between visits. But she is equally clear that virtual care is not a full substitute, especially in maternal health.
“Specifically for maternal health, there are certain visits that require in-person exams, ultrasounds, or lab testing that telehealth cannot replace,” she said.
That means communities need blended solutions. Fleming points to workforce development and diversification as a longer-term strategy to expand services, including potential partnerships with other providers in the area. Dentists, physical therapists, and others may be able to facilitate blood pressure checks or telehealth visits for patients with limited internet access at home. Expansion of midwifery or advanced practice nursing services may also help fill gaps.
She also emphasizes the importance of better communication with patients about when to seek care, where to go, and how to avoid dangerous delays. Transportation support, she said, can be essential.
A First-90-Days Playbook After Closure
If a county has just lost its surgical hospital, Fleming says leaders must begin with a clear picture of the community and its health care needs.
“The first best step is having a firm grasp of your community and their healthcare needs, what services are they utilizing the most, where are they traveling from and how often?” she said.
The next step is to identify the nearest available resources—from community practices to urgent care centers to the closest surgical hospitals—and communicate those options quickly and clearly to residents.
Case management should be part of the response from the start, Fleming said, so patients can understand insurance coverage at new facilities and get help accessing or transferring their medical records. That issue is especially important when hospitals close, because continuity of care can break down just when patients most need stable follow-up.
She would also move quickly to convene a broad group of stakeholders: leaders from local health care facilities, public health departments, transportation services, payors, and nonprofit organizations.
“Convening the leaders of local healthcare facilities, transportation services (both county operated and private), payors and non-profits would be essential in order to provide the best coverage and transition as possible,” she said.
An Equity Challenge—and A Leadership Challenge
For Fleming, a hospital closure is rarely just one institution’s problem. It is often a warning sign of broader instability.
“Unfortunately, when one hospital closes in an area it is a symptom of a broader problem and swift intervention can prevent rapid closures of other facilities,” she said.
Responding to surgical hospital closures may require policy action as well as local coordination. In the short term, she points to the possibility of reallocating state and federal funding to relieve pressure on the facilities that remain open. Longer term, the work is about building systems that are less likely to leave vulnerable communities exposed in the first place.
That is the kind of challenge Harvard Chan’s program is designed to prepare leaders to meet: understanding the structural roots of inequity, communicating across sectors, and making decisions that center those with the worst outcomes rather than treating them as an afterthought.
Because when a surgical hospital closes, the loss is not distributed evenly. And neither is the responsibility to respond.
