2020 Rural Hospital Sustainability Index

Trends in Rural Hospital Financial Viability, Community Essentiality, and Patient Outmigration

Following a 2019 Navigant study,1 we reanalyzed the correlation of financial viability and essentiality of rural hospitals across the country.

According to the analysis:

  • 25% of rural hospitals nationwide are at a high risk of closing unless their financial situations improve.
  • Of these hospitals, 82% are considered highly essential to their communities.

Additional analysis of migration patterns of patients who live in rural counties in six states shows: 

  • 76% of patients living in rural counties with a local hospital outmigrated for care (e.g., left their local area and hospital to receive care elsewhere), compared to 35% and 23% of suburban and urban patients, respectively.
  • As more complex care often can’t be provided at local hospitals, the analysis divided rural outmigration data into three levels based on patient acuity. We found that while rural hospitals should be able to keep most Level 1 cases (lower acuity conditions per which the hospital provides associated services), 68% of patients still outmigrated for this level of care.

These rural hospital and community struggles have been exacerbated by the COVID-19 pandemic, as they are with any downturn in the economy, both in the short- and long-term. Scroll down for state-based results and download the full analysis.


1David Mosley and Daniel DeBehnke, MD, “New Analysis Shows Worsening Situation for Rural Hospitals, Residents,” February 2019, https://guidehouse.com/-/media/www/site/insights/healthcare/2019/navigant-rural-hospital-analysis-22019.pdf 

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