Urban Hospitals Closing at Alarming Rates: New JAMA Study Insights

A new JAMA study finds urban hospitals closing at rates comparable to rural ones. The sharper divide is between types of hospitals: for-profit, small and safety-net facilities were the most likely to close.

When Delaware County, Pennsylvania, lost two hospitals in the spring of 2025, it happened in a Philadelphia suburb of roughly 576,000 people, not in a remote rural town. Taylor Hospital closed in late April. Days later, Crozer-Chester Medical Center, the county’s only trauma center, followed. According to Chief Healthcare Executive, a county that had six hospitals a few years earlier was down to two.

Public conversation about hospital closures still tends to picture small towns far from big cities. A study published October 8 in JAMA suggests that picture is incomplete. Urban hospitals are closing at rates comparable to rural ones, and some kinds of hospitals are far more exposed than others.

The Numbers Behind America’s Hospital Losses

Researchers at the Harvard T.H. Chan School of Public Health used the American Hospital Association’s annual survey to track 4,962 acute care hospitals from 2010 through 2025. A hospital counted as closed once it stopped providing inpatient care.

432 hospitals closed and 216 opened. The net loss was 216 hospitals and 24,399 beds.
Closures rose about 4% a year. Openings fell about 3% a year.
9.1% of urban hospitals closed, compared with 8.3% of rural hospitals. The difference was not statistically significant.

The gaps by hospital type were wider. For-profit hospitals closed at a rate of 21.4%, against 6.0% for nonprofits. Among safety-net hospitals, 13.7% closed, compared with 8.6% of hospitals that were neither safety-net nor critical access. By size, 12.4% of hospitals with 1 to 24 beds closed, versus 1.7% of those with 400 or more.

These are associations. They do not show that ownership, safety-net status or size caused any individual closure, and not every closed hospital fit all of these profiles. But closures were clearly not spread evenly across the system.

“Closed” did not always mean the building went dark. Of the 432 hospitals, 315 shut down completely. The other 117 kept some outpatient services, including 45 that converted to rural emergency hospitals.

Replacement was thin. New hospitals were mostly urban, for-profit and small, and safety-net hospitals rarely opened. New capacity was not necessarily replacing what communities had lost. Thomas Tsai, the study’s corresponding author, said policymakers should stop asking only how to save rural hospitals and ask how to protect access to hospital care for vulnerable communities, wherever they are.

Why a Hospital Can Be Surrounded by Patients and Still Close

A hospital in a dense area can still be financially fragile, because the number of people nearby says little about how their care is paid for. What counts is who the patients are, who covers them and whether reimbursement covers the cost of treating them.

The JAMA study describes who closed. It does not explain why any single hospital shut down. Payer mix is one part of the wider financial picture, though. A New York policy analysis notes that Medicaid pays less than half of what commercial insurers pay for the same services. A hospital serving many Medicaid or uninsured patients operates under different pressure from one with mostly commercially insured patients.

Ownership adds another layer. Prospect Medical Holdings acquired Crozer Health in 2016 and closed two of its Delaware County hospitals in 2022. It filed for bankruptcy in January 2025. Pennsylvania, the county and a local foundation put more than $40 million into keeping the last two hospitals open, and no buyer emerged. State and local officials blame private equity ownership for failing to invest in the facilities. That is their account of Delaware County, not a conclusion of the JAMA research.

When a Hospital Closes, Access Changes Even If Another Hospital Is Nearby

The distance data complicate the picture. In the JAMA study, the median distance from a closed hospital to the nearest operating one was 8.6 miles, and for 54.6% of closed hospitals another hospital sat within 10 miles. The effect of closure on distance was larger in rural areas.

So a closure does not automatically leave a community without a hospital nearby. But distance on a map is not access. Ten miles is not ten miles in traffic, drive time is not ambulance time, and the nearby hospital may not offer the same specialties, trauma capacity or referral relationships. After Crozer closed, local officials said many residents would be 30 to 40 minutes or more from the nearest hospital. That is a local estimate, not a finding of the national study.

For medical practices, the exposure depends on how tied they are to a particular hospital. A primary care practice that admits patients or refers to specialists at one facility faces a different risk from a stand-alone specialty clinic with several referral options. Three questions are worth asking:

Referral networks. If the hospital closes, where do referrals go? Is the alternative in the same network, and does it offer the services patients need?
Payer mix. If a practice relies on a hospital serving a financially vulnerable population, that hospital’s stability belongs in the practice’s planning.
Continuity of care. After Martin Luther King Jr. Hospital closed in Los Angeles in 2007, 28 of 42 primary care physicians interviewed said it had affected their practices. They described harder access to specialists, fewer direct admissions and slower emergency evaluations.

A practical first step for practices that depend on a given hospital: map where patients actually receive hospital care and confirm backup transfer arrangements with a second facility. Evidence on how closures affect the finances of independent practices is limited, and the national data do not support predicting revenue losses for them.

The Next Test: Medicaid Cuts and Urban Safety-Net Hospitals

The study covers closures through 2025. The One Big Beautiful Bill Act was signed on July 4, 2025, and many of its Medicaid provisions phase in over the following years, so the 432 closures cannot be attributed to it. The question is what comes next.

A Harvard analysis published in November 2025 identified 109 acute care hospitals as most vulnerable to the Medicaid cuts. Of those, 85% were urban. The Congressional Budget Office expects the law to leave about 7.5 million more people uninsured over the next decade. Congress created a $50 billion Rural Health Transformation Program, while the authors of the new JAMA letter note that no comparable support has been enacted for urban safety-net hospitals.

If urban hospitals are closing at rates similar to rural ones, and urban safety-net hospitals are among those exposed to Medicaid cuts, a strategy aimed mainly at rural hospitals may leave a lot of patients uncovered. The study does not predict which hospitals close next.

What to Watch

Whether urban closure rates stay comparable to rural rates as the Medicaid changes take effect.
Whether federal or state policy provides targeted support for safety-net hospitals in cities.
Whether replacement facilities keep the services, referral options and emergency capacity communities had before.

Rural hospitals still need help. The new data show that geography alone does not explain who loses a hospital: size, ownership and the population a hospital serves matter too.

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