Abstract
Are hospitals critical to the economic health of a rural county, and does being geographically connected to an urban area make a difference? This study examines the nation's 1,885 rural counties sorting them into counties that (1) had a hospital in 2013 and 2020, (2) had no hospital in 2013 and 2020, (3) had a hospital in 2013 but not in 2020, and (4) had no hospital in 2013, but gained one by 2020. A distinction is made between "connected" and "isolated" rural counties with connected counties defined as those contiguous to an urban county. Isolated rural counties are defined as counties that share no borders with an urban county. The analysis concluded that the lack of a traditional hospital had a statistically significant and negative impact on the economies of rural counties. However, the impact was much larger in both 2013 and 2019 for isolated rural counties. Furthermore, it was found that rural counties without hospitals, especially isolated counties, were more likely to fill the gap by adding alternative care facilities.