Table of Contents

December 2002

Executive Summary

I. Introduction

II. Providers and Access to Services

III. Financial Stability of Hospitals and Nursing Homes

IV. Theoretical Impacts of Health Care Institutions on Local Economies

V. Forty-Two Hospital Closures

VI. Ten Case Studies of Hospital Closure

VII. Conclusions

VIII. References

Technical Appendix

Introduction

Section A. Providers by County
Table A1-A. All Physicians in the County per AMA and AOA
Table A1-B. Primary care Physicians per AMA and AOA
Table A1-C. Full-time Dentists in the County per ADA

Section B. Availability of Hospital Services by County in 1994 and 2000
Table A-2. Emergency Services

Section C. Hospital Financial Condition
Table A-3. Characteristics of Hospitals by Category of Financial Condition
Table A-4. Hospitals At Risk of Closure as of 1-1-2000
Table A-5. Hospital Closures and Economic Impacts 1986-1996
Figure A-1. Graph of Employment Changes Pre and Post Hospital Closure
Figure A-2. Graph of Population Changes Pre and Post Hospital Closure
Figure A-3. Graph of Income Changes Pre and Post Hospital Closure

Section D. Skilled Nursing Facilities Financial Condition
Table A-6. Characteristics of SNFs by Category of Financial Condition in 1999
Table A-7. SNFs Medicaid Data
Table A-8. Skilled Nursing Facilities At Risk of Closure as of 1-1-2000

Section E. Glossary
Table A-9. Variable Definitions and Sources

Report prepared by:
Jeffrey Stensland, Ph.D.
Curt Mueller, Ph.D.
Janet Sutton, Ph.D.
Project HOPE
Center for Health Affairs
7500 Old Georgetown Road
Suite 600
Bethesda, Maryland 20814-6133

Prepared for:
Appalachian Regional Commission
Washington, D.C.