Chartis Study Finds Rural Health Safety Net Under Threat from Reimbursement Pressure, Dwindling Access to Care and Declining Population Health Status

Chartis, a leading healthcare advisory firm, today released new research revealing widespread instability across America’s rural health safety net. Findings from the study “2025 rural health state of the state: Instability continues to threaten rural health safety net,” will be shared with members of Congress, rural healthcare advocates, and state offices of rural health during the National Rural Health Association’s 36^th annual Rural Health Policy Institute Conference in Washington.

“This study confirms that the rural health safety net is under immense pressure and struggling to find any measure of stability. Far too many rural hospitals are operating in the red and our analysis suggests that care deserts are likely to grow through future closures, facility conversions or the elimination of services too costly to maintain,” said Michael Topchik, Executive Director, The Chartis Center for Rural Health. “This reality is particularly worrisome given our analysis of population health domains, which indicates that rural hospitals will be challenged to meet the needs of vulnerable communities in the years ahead.”

Building on previous studies, this latest research analyzes key safety net indicators such as hospital operating margin, rural hospital vulnerability, and the loss of access to services, including obstetrics and chemotherapy. A more nuanced exploration of rural population health status provides an additional layer of context for understanding the breadth of safety net instability. Key findings from this study include:

• 46% of rural hospitals in America have a negative operating margin.
  
  
• 432 rural hospitals are vulnerable to closure.
  
  
• In the 10 states yet to expand Medicaid under the Affordable Care Act, 53% of rural hospitals are operating in the red.
  
  
• 293 rural hospitals stopped offering OB services between 2011 and 2023, while 424 ceased chemotherapy services between 2014 and 2023.
  
  
• Social drivers of health indicators show rural communities have lower median household income (-36 percentile points) and higher rates of child poverty (+16 percentile points) when compared with their urban peers.
  
  
• Rural Americans carry a larger share of the chronic disease burden with higher rates of adult obesity (+30 percentile points) and have higher rates of premature death (+20 percentile points) than their urban counterparts.
  
  
• Nearly 25% of all veterans reside in rural communities. Access to care challenges mean that this segment is particularly vulnerable.

Resources

The study, “2025 rural health state of the state: Instability continues to threaten rural health safety net” is available for download at https://www.chartis.com/insights/2025-rural-health-state-state.

About Chartis

The challenges facing US healthcare are longstanding and all too familiar. We are Chartis, and we believe in better. We work with more than 900 clients annually to develop and activate transformative strategies, operating models, and organizational enterprises that make US healthcare more affordable, accessible, safe, and human. With more than 1,000 professionals, we help providers, payers, technology innovators, retail companies, and investors create and embrace solutions that tangibly and materially reshape healthcare for the better. Our family of brands—Chartis, Jarrard, Greeley, and HealthScape Advisors—is 100% focused on healthcare and each has a longstanding commitment to helping transform healthcare in big and small ways. Learn more.

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