Closing underperforming hospitals could worsen health inequality in rural areas, finds new study

Closing underperforming hospitals may do more harm than good, particularly in rural areas -regardless of their performance status, according to new research from the University of Surrey. The study shows that while the promise of improved care quality often justifies hospital closures, they risk exacerbating health inequalities, particularly for patients who already face longer travel distances for treatment. 

The study, published in Regional Science and Urban Economics, which focused on elective hip replacement patients in England, found that the negative impact on patient welfare from hospital closures is significantly greater in rural areas. Patients who relied on the closed facilities could experience a utility loss equivalent to travelling an additional 10.25 kilometres for treatment.  

The study highlights several alarming trends. While patients in urban areas typically travelled shorter distances to receive care because they could access a higher number of hospitals to get treatment, the average patient travelled 17.4km.  As such, the researchers show that the average distance travelled would increase substantially if hospitals in rural areas were closed. This is particularly concerning given that rural patients often have fewer alternatives available to them. The research suggests that any closure in these regions is likely to widen the existing gap in healthcare access between urban and rural populations, resulting in greater health disparities. 

Dr Giuseppe Moscelli, Associate Professor of Economics and co-author of the study at the University of Surrey, said: 

"Our findings reveal a crucial, often overlooked consequence of hospital closures: the significant toll they take on rural patients who already have limited access to healthcare. While improving hospital quality is essential, it cannot come at the cost of accessibility for those who need it most." 

The team analysed patients' choices of hospitals for elective hip surgery to simulate the effects of closing eight hospitals identified as the lowest quality. These hospitals were assessed based on health indicators such as emergency readmission rates and health gains measured by the Oxford Hip Score. By observing patient choices and calculating the resulting changes in travel distance, quality of care, and overall patient welfare, the researchers could estimate the potential fallout from these closures. 

Researchers recommend a more nuanced approach to hospital management and closure policies. Rather than shutting down facilities based solely on performance metrics, regulators should consider the broader implications of such decisions on patient access and equity.  

Dr Moscelli continued: 

“This includes maintaining a network of hospitals in both urban and rural areas that meet quality standards while ensuring they remain accessible to the populations they serve.” 

The Government’s decision to reintroduce league tables for NHS hospital providers in England makes considerations about the trade-offs between quality benchmarks and the accessibility of hospital care across differently served geographies even more salient. 

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Note to editors:   

• Dr Giuseppe Moscelli is available for interview, please contact mediarelations@surrey.ac.uk to arrange