I'm sorry to say but there is a lot of nonsense in the other comments here. I wrote Hacking Healthcare for O'Reilly, created the ClearHealth/HealthCloud Open So

I'm sorry to say but there is a lot of nonsense in the other comments here. I wrote Hacking Healthcare for O'Reilly, created the ClearHealth/HealthCloud Open Source EMR system, and most importantly I have, amongst other things, actually managed dozens of rural hospitals and clinics. First for context, the Center for Healthcare Quality and Payment Reform (CHQPR) is an advocacy organization for the types of institutions this report discusses. I think that is important context. Second, what is rural? From a healthcare standpoint rural typically refers to area of populations centers of 50,000 people or less. Examples in California that might be familiar to people living in the San Francisco bay area would be Humbolt and Mendocino counties. This report includes some semi-rural areas, places similar to something like Yuba City, CA, a population center of about 160,000. Thirdly, the main point is that what "rural" hospitals get paid for services from insurance companies and what it actually costs to provide those services, continues to get further and further apart. In my first hand experience, this is true. Number one amongst those is staffing, today staffing costs have risen dramatically faster in rural areas than in urban and semi-urban areas -- though they have risen their as well. The staffing levels and types of personell at what is legally called a hospital are heavily regulated and have continued to to expand. Medicare in particular is pretty "unfair" in its latest fee structures regarding these issues though HHS does provide other types of subsidy to rural areas. The meat of the report is that if that continues unabated, one hundred or more hospitals will likely "close". Closing may mean to completely cease operation or in other cases mean to continue to operate but as something which cannot legally be called a "hospital". Finally, as a report which is not really in-depth, not really independant of the organizations it is advocating for, provides little in the way of citations and data, I am somewhat dubious of its value being posted to HN at all, other than to act as a punching bag around which everyone can throw the usual jabs at the US healthcare system as a whole.