A Harvard T.H. Chan School of Public Health study in JAMA analyzed U.S. hospital closures and openings from 2010 through 2025. It found urban hospitals closed at 9.1% and rural at 8.3%, a narrow gap that challenges the common focus on rural distress alone. Closures rose about 4% annually while openings fell about 3% annually, according to the researchers.
During the period, 432 hospitals closed and 216 opened, producing a net loss of more than 24,000 beds. About 73% of closed hospitals shut entirely; the rest kept outpatient services, including rural emergency care. Hospitals most at risk included for-profit, small, safety-net facilities and those serving counties with higher poverty or limited transportation.
New hospitals were mostly urban, for-profit and small. Closures were concentrated in the Midwest and South, and more occurred in states that did not expand Medicaid under the Affordable Care Act. The study arrives as health systems assess the One Big Beautiful Bill Act, signed in July 2025. CBO estimates the law will reduce federal Medicaid spending by $886.8 billion over a decade, while it provides $50 billion in rural health grants over five years with limits on hospital benefit.