Recent Rural Hospital Closures and Service Disruptions in the United States: A Rapid Systematic Review

Rural hospitals are essential access points for healthcare delivery in the United States, yet they continue to experience disproportionate rates of closure and service disruption that threaten community health, economic stability, and equity. This rapid systematic review synthesizes recent peer-reviewed evidence examining rural hospital closures and service disruptions, with emphasis on financial, policy, workforce, and performance-related factors and their downstream impacts. Guided by PRISMA methodology, four databases were searched for U.S.-based studies published between January 2024 and June 2025. Following screening and consensus-based review, 59 articles met inclusion criteria. Across studies, financial vulnerability, characterized by revenue instability, low patient volumes, unfavorable payer mix, and reliance on non-operating revenue, emerged as a dominant precursor to closure and service reductions. Policy context, particularly Medicaid expansion status, telehealth and broadband infrastructure, and reimbursement adequacy, strongly shaped hospital sustainability. Closures and service disruptions were consistently associated with increased travel distances, reduced access to maternal, surgical, mental health, and chronic care services, higher prices at surviving hospitals, and increased strain on remaining providers. Workforce shortages further compounded these challenges. Collectively, findings demonstrate that rural hospital closures reflect interconnected structural weaknesses rather than isolated organizational failure. Coordinated policy action, targeted financial stabilization, workforce development, and technology-enabled care models are necessary to mitigate continued erosion of rural healthcare access.