A hospital closure changes what it means to live in a community. A parent may need a longer journey for urgent care. An older resident may have to find someone willing to drive farther for treatment.
The financial decision happens inside an institution, but its consequences follow people home.
Rural America deserves a stronger response than sympathy after services disappear. I believe hospital leaders should make reviewing and recovering legitimate insurance payments part of protecting access to care, before reducing services becomes the default response to financial pressure.
That responsibility belongs alongside the broader reforms rural healthcare needs.
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The U.S. Census Bureau counted approximately 66.3 million rural residents in 2020, representing approximately 20 percent of the population.
Their circumstances differ, but living outside a city should not make dependable healthcare an unreasonable expectation. These are places where people raise families, build businesses, and care for aging parents.
The losses are substantial. The University of North Carolina’s Sheps Center currently records 109 complete rural hospital closures since January 2005, alongside 88 conversions that ended inpatient services while retaining some healthcare services.
Those categories matter. A facility that still offers appointments may nevertheless be unable to provide the hospital care its community previously relied on.
Distance makes that loss tangible. A Government Accountability Office analysis, published in 2020, found that the median distance to general inpatient care increased by about 20 miles in the service areas of rural hospitals it studied after closures.
That historical finding illustrates what a budget discussion can overlook. Care available somewhere else is not necessarily care that a family can easily reach.
Review of Claims Vital
Today's financial pressures make these questions urgent. An October Becker’s Hospital Review report, citing Kaufman Hall’s analysis of August 2026 data from 1,300 hospitals, reported that approximately 43 percent were operating at a loss.
This is a broader hospital sample, not a rural-only estimate, but it underscores the difficult environment in which leaders are making decisions.
I am not here to criticize teams already trying to keep essential services available. When resources are stretched, asking employees to pursue every disputed payment without additional support is hardly a workable strategy.
My concern is whether leadership gives that work the attention, capacity, and accountability it deserves.
Before approving a service reduction, boards should request a documented review of unpaid and potentially underpaid insurance claims.
Which payments remain unresolved? Which differ from contracted amounts? Which denials warrant an appeal? Who owns the follow-up, and does that team have enough time to complete it?
That review must be realistic. A disputed claim is not automatically money owed, and an outstanding balance is not cash available to spend.
Hospitals should distinguish valid payment disputes from documentation errors, legitimate denials, and amounts unlikely to be recovered. Decisions should rest on evidence, not optimistic collection forecasts.
The priority I am proposing is accurate payment from insurers for covered care already delivered.
The Need For Better Payment Follow-up
Hospitals also need room to choose how they do this work. Some may strengthen internal teams; others may share expertise or use outside support.
Any arrangement should be judged by recoveries after costs, accuracy, privacy protections, and whether it preserves staff capacity for patient care.
Better payment follow-up cannot make every service sustainable or replace adequate reimbursement and public investment.
Still, it may give some hospitals more room to retain staff or maintain services. Leaving recoverable payments unresolved while considering cuts risks narrowing options before leaders have fully examined them.
Hospitals should have the ability to properly assess their situation before approving financially driven service reductions, giving them the ability to assign an executive to oversee it and review progress regularly.
Insurers should provide clear explanations and timely resolution of valid disputes. Where reductions remain necessary, communities deserve an explanation of the alternatives examined and a practical plan for continued access.
Rural families cannot resolve these institutional problems themselves. They can reasonably expect those responsible for their healthcare to pursue the options within reach. Protecting local care should begin before the closure announcement.
Don Meyer is CEO of Enterprise Cost Reduction, which helps hospitals identify and recover insurance underpayments. All opinions are the author’s own.