Hospital Closures: 1990 - 1999 
OEI-04-02-00180

Prepared by:  Office of Inspector General  December 2001 
Office of Evaluation and Inspections 
Atlanta Regional Office  December 11, 2001

Jesse Kerns

Policy Analyst

MedPAC

1730 K. Street, Suite 800

Washington, DC  20008

Dear Mr. Kerns:

This report responds to your request for information on the closure, opening, and reopening

of hospitals in the United States during the 1990's.

For the past thirteen years, the Office of Inspector General (OIG) has released reports

describing the extent, characteristics, reasons for, and impact of hospital closures in the

United States.  The hospital closure reports focused on general, short-term, acute inpatient

care hospitals.

We analyzed trend data on hospital closures, openings, and reopenings from 1990 through

1999.  Based on our analysis, the United States ended the 1990's with 340 fewer general,

short term, acute care hospitals than when the decade began.  In total, 440 hospitals closed,

78 hospitals opened, and 22 previously closed hospitals reopened.  Fifty-eight percent (254)

of the hospitals that closed were located in urban communities.  The remaining 42 percent

(186) were located in rural communities.

The following pages details our study methodology and findings.

I hope this information is helpful in meeting your needs.  If you have any questions, please

do not hesitate to contact me or Graham Rawsthorn at 404-562-7723.

Sincerely,

Jesse J. Flowers 
Regional Inspector General for 
Evaluation and Inspections 
Page 1 of  4 
Hospital Closures: 1990 - 1999  OEI-04-02-00180  METHODOLOGY 
We analyzed 10 years of data that we collected as part of our annual tracking of hospital closures, 
openings, and reopenings throughout the United States. 
We used the Centers for Medicare & Medicaid Services (CMS) Hospital Cost Report 
Information System (HCRIS) data to identify general, short-term, acute inpatient care hospitals. 
We further analyzed the HCRIS data to determine if hospitals that closed were located in urban or 
rural communities.  To verify the status of hospitals, we obtained information from State licensing 
and certification agencies, State health planning agencies, State hospital associations, local public 
officials, and officials associated with closed hospitals or nearby hospitals. 
We considered a hospital closed only if it stopped providing general, short-term, acute inpatient 
care for the calendar year of study.  We did not consider a hospital closed if it: 
!  Merged with or was sold to another hospital but the physical plant continued to 
provide inpatient acute care, 
!  Converted to a critical access status, or 
!  Both closed and reopened in the same calendar year and physical plant. 
HOSPITAL CLOSURES 
The number of hospital closures were generally low throughout the 1990's.  The lowest number of 
closures occurred in 1994 as shown in the following table. 
HOSPITAL CLOSURES: 1990 - 1999 
Calendar 
Year  Rural  Urban  Total 
1990  28  28  56 
1991  36  21  57 
1992  26  24  50 
1993  22  20  42 
1994  5  11  16 
1995  13  24  37 
1996  10  27  37 
1997  10  28  38 
1998  15  28  43 
1999  21  43  64 
1990-1999  186  254  440 
Percent of  42%  58% 
Closures 
Page 2 of  4 
Hospital Closures: 1990 - 1999  OEI-04-02-00180  Our data shows that hospital closures were generally proportionate to the rural/urban dispersion 
of hospitals.  To illustrate, 45 percent of the nations hospitals were located in rural communities. 
Over the past decade, rural communities accounted for 42 percent of hospital closures.  Likewise, 
55 percent of the nations hospitals were located in urban communities and they accounted for 58 
percent of hospital closures. 
HOSPITAL OPENINGS AND REOPENINGS 
During the 1990's, hospital openings and reopenings fluctuated.  On average, eight hospitals 
opened or reopened each year from 1990 through 1997.  However, during 1998 and 1999, we 
found a substantial increase in the number of hospitals that opened or reopened.  The average for 
the last two years of the decade was 18 hospitals.  As shown in the following table, 100 hospitals 
either opened or reopened from 1990 through 1999. 
HOSPITAL OPENINGS AND REOPENINGS: 
1990 - 1999 
Calendar 
Year  Openings  Reopenings  Total 
1990  7  2  9 
1991  8  1  9 
1992  7  0  7 
1993  8  5  13 
1994  6  7  13 
1995  4  1  5 
1996  4  1  5 
1997  2  1  3 
1998  12  2  14 
1999  20  2  22 
1990-1999  78  22  100 
NET EFFECT OF CLOSURES, OPENINGS, AND REOPENINGS 
The United States ended the 1990's with 340 fewer hospitals than when the decade began.  As 
shown in the following table, the most (net) closures came early in the decade.  The fewest 
number (net) of closures was in 1994 -- three hospitals closed. 
Page 3 of  4 
Hospital Closures: 1990 - 1999  OEI-04-02-00180  NET EFFECT OF CLOSURES, OPENINGS, AND REOPENINGS: 
1990 - 1999 
Calendar  Net 
Year  Close  Open  Reopen  Closures 
1990  56  7  2  47 
1991  57  8  1  48 
1992  50  7  0  43 
1993  42  8  5  29 
1994  16  6  7  3 
1995  37  4  1  32 
1996  37  4  1  32 
1997  38  2  1  35 
1998  43  12  2  29 
1999  64  20  2  42 
1990-1999  440  78  22  340 
Beginning in 1998, we tracked whether hospitals that opened or reopened were located in rural or 
urban communities.  The following table shows the net effect of closures, openings, and 
reopenings by rural and urban communities. 
NET EFFECT ON RURAL AND URBAN COMMUNITIES: 1998 - 1999 
Closure  Opening  Reopening  Net Closures 
Calendar 
Year  Rural  Urban  Rural  Urban  Rural  Urban  Rural  Urban 
1998  15  28  3  9  1  1  11  18 
1999  21  43  6  14  0  2  15  27 
1998-1999  36  71  9  23  1  3  26  45 
Page 4 of  4 
Hospital Closures: 1990 - 1999  OEI-04-02-00180