Transforming the Rural Health Care Paradigm

The coronavirus disease 2019 (COVID-19) pandemic is exposing the fragility of health care in rural areas of the US. The pandemic-related hospital financial crisis may exacerbate the long-standing rural hospital closure crisis, worsening preexisting rural health disparities. 1 COVID-19 is spreading in a "checkerboard" pattern through hot spots in rural areas. Rural health care facilities have undergone significant and costly preparations for potential surges of patients with COVID-19. Yet they may still be overwhelmed by a local outbreak, facing intractable clinician shortages and lack of regional planning for patient transfers. 2 Thus, COVID-19 highlights a wicked problem for rural hospitals-they are repeatedly forced into a reactionary pattern regarding finances, staffing, and transfer/coordination networks that hinders their ability to optimize care delivery and quality. The consequences to communities experiencing rural hospital closures are tragic, starting with loss of health care access and ending with community decline. It is time for a new paradigm.