Preserving healthcare close to home
Rural hospitals are a quiet but vital part of life in Missouri. They provide emergency care, deliver babies, treat chronic illness, and serve as major employers in communities that already face economic challenges. Today, those hospitals are under growing strain as populations and reimbursement declines all while costs increase.
According to the Missouri Hospital Association (MHA), 25 hospitals have closed statewide since 2014, many of them in rural areas and with more facing closure. These closures are not isolated events; they are warnings. In towns where a hospital shuts its doors, residents must travel farther for care, employers struggle to recruit workers, and communities lose one of their strongest anchors.
The pressures on rural hospitals are largely structural as they face smaller patient populations meaning higher costs per patient. A large share of rural hospital patients rely on Medicare and Medicaid, programs that frequently do not reimburse the full cost of care. Medicare and Medicaid also continue to face funding cuts at the federal and state levels. As a result, MHA reports that many rural hospitals operate on profit margins hovering near zero, leaving them with little room to manage rising supply costs, aging facilities, or sudden staffing gaps.
Nurse, physician, and technician shortages are common nationwide, but rural hospitals face steeper barriers to recruitment. The Missouri Hospital Association’s 2025 Workforce Report shows that while vacancy rates have improved since the pandemic, turnover remains high statewide. When even one physician leaves a small hospital, entire services – such as emergency coverage or maternity care – can be lost.
Missouri has already seen the consequences. Across the state, rural maternity units have closed after hospitals were unable to recruit obstetric providers creating maternity deserts. Expectant mothers are now driving 45 minutes or more to give birth, increasing stress and risk for families at one of life’s most critical moments.
The rural healthcare crisis is a problem where all citizens in Missouri will need to participate in the solutions. Our local and state government officials alike will need to recognize that rural hospitals are not just healthcare providers – they are economic engines, essential services, and community safety nets. In some of our rural communities the hospitals or healthcare systems are the largest employer as they serve such a geographical large area.
Many hospitals are already working to adapt, forming regional partnerships, expanding telehealth services, and sharing resources where possible. These efforts deserve support from the communities in which they serve and from the state of Missouri. Decision makers in healthcare continue to explore practical solutions that strengthen reimbursement models, expand workforce pipelines, and protect access to care for rural Missourians. Once a rural hospital closes, reopening it is extraordinarily difficult. Preventing closures is far more effective – and far less costly – than trying to rebuild after the fact.
Ensuring access to healthcare close to home is a shared Missouri value. Preserving rural hospitals and healthcare is about protecting the health and quality of life for our people, our communities, and the long term health of the state we all call home.
Amanda Evans is a registered health information administrator (RHIA)
