Where America's Hospitals Are Closing — and Opening

Today we are launching the interactive hospital Closures and Openings Explorer, a new feature of our Hospital Markets Explorer tool, which shows where hospitals opened and closed between 2000 and 2026. The tool also tracks how hospital beds per thousand residents have changed at the national, state, county, and commuting-zone level. Alongside this feature, we have updated the tool’s underlying data, which is now current through June 1, 2026.¹

Hospital openings and closures have played a major role in reshaping hospital markets over the past 25 years. Until now, market changes have been hard to track clearly, especially at the local level. As hospital market dynamics continue to shift in response to the implementation of the One Big Beautiful Bill Act (OBBBA), the Closures and Openings Explorer can help policymakers, journalists, researchers, and others understand which communities have experienced shifts in hospital capacity. We update the data underlying the tool biannually, so analysts can have up-to-date information on how markets are evolving. 

Insights from the Closures and Openings Explorer

Hospital openings and closures have reshaped hospital markets in the United States over the past two decades. In 2001, there were 4,957 hospitals and 2.8 beds per thousand residents. Our data show that between 2001 and 2023, 644 hospitals across the country closed and 502 opened, a net loss of 142 hospitals, contributing to a decline of 0.6 beds per thousand residents.² Nearly 60 percent of states experienced more hospital closures than openings during this period. However, 33 percent gained more hospitals than they lost, and 5 states experienced no net change. By contrast, the number of beds per thousand residents decreased in every state.

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While most states lost hospitals (on net) between 2001 and 2023, the extent of change within states varied markedly. California, New York, Pennsylvania, Georgia, and Michigan have had the highest net losses of hospitals (see Figure 1). 

States that experienced the greatest increase in the number of hospitals tend to have high levels of population growth. Texas, Colorado, Arizona, Florida, Nevada, and Wisconsin experienced the greatest net hospital openings (see Figure 2). 

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When examining changes to hospital beds per thousand residents, the landscape across states changes. North Dakota, Montana, Nebraska, South Dakota, and the District of Columbia experienced the largest decreases in beds per thousand residents from 2001 to 2023, while Connecticut, Alaska, Nevada, Arizona, and Massachusetts experienced the smallest decreases. 

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In 2026, the 5 states with the most beds per 1,000 residents are North Dakota, South Dakota, Mississippi, West Virginia, and Wyoming. The states with the fewest beds per 1,000 residents are Utah, Washington, New Mexico, Nevada, and Idaho. 

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The Evidence on Hospital Closures and Openings

A growing body of research has examined the forces behind closures and openings and how they affect patients and communities. Hospital closures are driven by several factors. Part of the decline reflects a shift in where care is delivered: major procedures such as hip and knee replacements, for example, have moved from inpatient to outpatient and ambulatory-surgery settings (CMS 2017, 2019; MedPAC 2025; Chen et al. 2026). Most closures, however, are the result of hospitals’ financial distress: hospitals with narrow margins and heavy reliance on public payers are the most vulnerable (Bai et al. 2020). These pressures are most acute in rural areas facing declining populations and less favorable payer mixes (Hodgson et al. 2015; Carroll 2023; Gujral & Basu 2020). Public policy has sought to counter these pressures: the Affordable Care Act's Medicaid expansion reduced closure risk, particularly in rural markets (Lindrooth et al. 2018), and the federal Critical Access Hospital program reimburses most rural hospitals on a cost basis for Medicare care (instead of the prospective payment system) to help low volume hospitals stay open (Carroll 2023). Openings, by contrast, are concentrated in fast-growing states, tracking population growth more than policy.

The evidence on the consequences of closures for patients and communities is mixed. In general, the effects of closures depend on the quality of the closing hospital relative to the alternatives available to them. Some hospital closures, for example, lower average mortality since patients shift their care to higher-quality facilities (Chandra, Dalton & Staiger 2023). In contrast, there is evidence that some rural hospital closures are associated with higher inpatient mortality and lower spending, with disproportionate effects on Medicaid enrollees and minorities (Gujral & Basu 2020; Carroll 2023). Hospital openings have received less attention, though recent work finds that entry increases the use of care (Petek 2022) and that new hospitals enter where they can provide higher-quality care, with lower mortality than incumbent hospitals in the same markets (Baker & Stratmann 2025).

The Closures and Openings Explorer offers both stakeholders and researchers a useful way to visualize how openings and closures are reshaping the hospital landscape, and a starting point for more in-depth analysis.

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Visit the Closures and Openings Explorer here: https://markets.healthcareaffordabilitylab.org/closures-explorer 

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¹The Explorer tools are a rigorous measure of a specific, policy-relevant slice of the hospital landscape — not a count of every type of facility. The tools include general short-term, acute-care facilities operating between 2000 and June 1, 2026. A hospital is counted as closed in the final year it appears in the data and opened in the first year it appears. Hospital openings are not tracked systematically in 2000, 2024, 2025, or 2026; therefore, the data on net closures and net openings in this commentary cover 2001 to 2023. The tools do include total closures from 2000 through June 1, 2026, and they use 2000 as the baseline year for estimates of change over time.

²The Explorer tools show that year-over-year changes in hospital counts do not equal the net changes (as measured by openings minus closures) for two reasons. First, because a closed hospital is still counted in its closing year, a recorded closure lowers the count the following year rather than the year it occurs, while a recorded opening raises the count in the same year. As a result, we do not exclude the 31 hospitals that experienced closures in 2023 from our total 2023 count, and we do include the 14 hospitals that experienced openings in 2001 in our 2001 count. Second, hospitals that experience gaps in reporting but later reappear in the data are excluded from the count during their missing years. In this case, one hospital closed in 2014 and reopened in 2024, and it is not included in our 2023 count of hospitals.