The Government Accountability Office publicly released a report September 19 entitled “Urban Hospitals: Factors Contributing to Selected Hospital Closures and Related Changes in Available Health Care Services.”

As noted in GAO’s cover letter:

“Hospitals play a critical role in delivering health care services to their communities. In 2022, nearly 30 million patients were admitted to approximately 4,500 general acute care hospitals nationally, and spending on hospital services accounted for about $1.38 trillion, nearly one-third of the $4.5 trillion in total health care spending in the U.S.[1] As of 2022, approximately half of U.S. general acute care hospitals were located in an urban area.

“There were 118 hospital closures in both rural and urban areas from fiscal year 2019 through fiscal year 2023.[2] Closures of urban hospitals outpaced openings from 2019 through 2023, with 72 closures and 55 openings nationally in this time period.[3] Some of these recent urban hospital closures included a history of private equity investment.[4]“

For its report, the agency looked at five urban hospitals which closed in 2022 or 2023. They found:

“All five selected urban hospitals experienced multiple years of financial decline prior to closure due to financial losses or declining profits, according to representatives from these hospitals and our analysis of CMS Medicare Cost Report data.[22] Several other factors contributed to the hospitals’ financial decline and closure; these included low or declining inpatient volume, aging physical infrastructure, challenges operating as independent hospitals, poor management practices, and separate ownership interests (see fig. 1).[23]“

The report also notes:

“Some community residents continued to face challenges accessing health care services after the closure of all selected hospitals, according to stakeholders. Stakeholders reported an ongoing lack of transportation, primary care, and insurance coverage.

“Some community residents faced inadequate transportation options, and the closure of selected hospitals may have made travelling to obtain health care services more difficult, according to stakeholders for all five selected hospitals.[50] For example, stakeholders in hospital B’s community noted that traveling to a hospital located 4 miles from hospital B could be challenging without access to a vehicle, and one of them also said getting there requires crossing a river that was a barrier between communities in the city. In another community, a hospital located 4 miles from hospital E was accessible via public transportation; however, representatives said traveling there could still be challenging for community residents unable to pay for public transportation. Some hospitals we interviewed provided transportation assistance for residents in their communities. For example, a hospital located about 5 miles from hospital A provided financial assistance with transportation, but hospital representatives noted that funding for this assistance was limited.

“Some community residents relied on the emergency department for health care needs such as primary care, according to stakeholders for four selected hospitals (hospitals A, B, D, and E). Therefore, the closure of the selected hospitals’ emergency departments may have exacerbated access challenges for individuals without access to primary care providers.[51] In addition, some residents of hospital B’s community could have difficulty accessing health care services from providers after the hospital’s closure in part because they lacked awareness of other providers, according to hospital B representatives. In hospital A’s community, residents—many of whom were immigrants—identified with hospital A’s Christian mission, had built relationships over many years with its staff, and did not feel the same connection with other providers, according to stakeholders.

“The lack of insurance coverage was another ongoing challenge faced by some residents in the communities of at least three selected hospitals (hospitals A, D, and E), according to stakeholders.[52] Uninsured individuals are more likely to delay or forego health care for financial reasons.[53] Representatives of all three of these hospitals stated that many of their patients were uninsured. For example, hospital E was a safety-net hospital, and a hospital representative reported that 38 percent of its patients were uninsured in the year before it closed. When hospital E was in operation, a staff person was available to help its uninsured patients enroll in insurance coverage through Medicaid or Medicare, according to a hospital representative. In addition, an estimated 20 percent of residents were uninsured in the cities where hospitals A and D were located.[54] Uninsured residents in hospital D’s community faced greater challenges accessing health care services after the hospital closed, according to one stakeholder, and the uninsured in other communities where selected hospitals closed may have faced similar challenges.”

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other OECD member nations.

Page last updated October 17, 2025 by Doug McVay, Editor.