Rural & Underserved Health Research Center Publications


We measure one aspect of how access to emergency care through ambulance services changes for patients when a hospital closes. We empirically estimate the time needed to transport a patient to an emergency department in an ambulance in the period immediately after the hospital closes. We find urban patients in zip codes where a hospital closes have a small change in transportation time, where rural patients average an estimated 15.7 additional minutes – a 46% increase compared to the year before the closure. This increase is primarily the result of an almost 100 percent increase in the time it takes to transport a patient from the location of the incident to the hospital. The impact on rural Medicare-eligible patients is even larger. We find no change in the time it takes ambulances to arrive at an incident and only a small change in the time spent at the scene.

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Notes/Citation Information

This report was also published as an IZA Discussion Paper (IZA DP No. 12797) and is available online at

Funding Information

This project was supported in part by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement # U1CRH30041.

Kenneth Troske completed some of the work on this project while visiting IZA and he thanks them for financial support.

Related Content

Troske, S., Davis, A., Troske, K. R., & Chaudhary, S. (2020). Urban and rural hospitals closures and short-run change in ambulance call times [research data]. UKnowledge Economic Research Data.