AHA Report Outlines Challenges Affecting Rural Communities, Opportunities to Ensure Access to High-Quality, Affordable Care

Nearly 20 percent of Americans live in rural areas and depend on their hospitals as important, and often only, sources of care in their communities

WASHINGTON (February 4, 2019) – The American Hospital Association (AHA) today released a report outlining the persistent, recent and emergent challenges that threaten rural hospitals’ ability to maintain access to health care services in their communities. The report, Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-quality, Affordable Care, underscores the importance of local access to essential health services, as well as the economic impact rural hospitals have on their communities.

According to the North Carolina Rural Health Research Program, 95 rural hospitals closed between 2010 and 2018. In addition, an August 2018 Government Accountability Office report found more than twice the number of rural hospitals have closed during the last five years than the previous five-year period.

“Rural hospitals are not just access points for care, they are cornerstones of care for the communities they serve,” said AHA President and CEO Rick Pollack. “In spite of their unique challenges, providing access to quality care where and when their patients need it will always be the goal of rural hospitals.”

While rural hospitals continue to struggle with low patient volumes and geographic isolation, they also must confront issues such as economic fluctuations, increased regulatory burden and the opioid epidemic.

New models of care can offer alternative ways of delivering and paying for health care services in rural communities. One recent proposal is to establish a new Medicare designation for an emergency medical center that would allow existing small rural hospitals to maintain emergency and outpatient care without having to provide inpatient services. The Center for Medicare & Medicaid Innovation is also conducting several demonstrations for rural providers. Additional opportunities are needed to explore new models of care that are flexible and meaningful for rural communities.

However, rural communities need comprehensive solutions. The AHA believes that federal policies must be updated for delivering care in the 21st century and new investments must be made to protect access to care in rural communities.


The AHA is working to advance policy priorities across several key areas for rural health, including:

  • Fair and adequate reimbursement that updates Medicare and Medicaid payment rates to cover the cost of care;
  • New models of care that improve financial predictability, and include rural providers in the movement toward value-based care;
  • Regulatory relief from antiquated and burdensome requirements that do not improve patient care;
  • Expanded access to telehealth and broadband services, and ensuring health information technology costs and compliance requirements are addressed to ease the burden on rural hospitals;
  • Workforce programs targeting rural areas that continue to be hard-hit by provider shortages; and
  • Prescription drug price concerns, including unsustainably high drug costs and attacks on the 340B program, which supports vulnerable communities.


The challenges faced by rural hospitals are complex, requiring policymakers, providers and communities to work together, innovate and leverage unique strategies to pave the way for the future of rural health care. The federal government must play a principal role by updating policies and investing new resources in rural America.


Rural Report Executive Summary: Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-quality, Affordable Care


Infographic: Rural Hospitals and Health Systems – Ensuring Local Access to High-quality, Affordable Care





Arika Trim, (202) 626-2319 atrim@aha.org

Marie Johnson, (202) 626-2351 mjohnson@aha.org


About the AHA

The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the improvement of health in their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks and other providers of care. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit the website at www.aha.org.