Farther to Care: What Hospital Closures Mean for Getting Injured Workers to Treatment
New WCRI research finds that rural hospital closures change where injured workers receive care, not whether they receive it. The difference shows up in the logistics.
When a hospital closes, the first question most people ask is whether patients will still get the care they need. For workers' compensation, the Workers’ Compensation Research Institute (WCRI) has an answer grounded in data, and it is more nuanced than most headlines about rural health care suggest.
WCRI's study, Impact of Hospital Closures on Access to Care and Claim Outcomes, is the first to examine hospital closures inside the workers' compensation system. Researchers Bogdan Savych and Olesya Fomenko analyzed more than 12 million claims across 29 states, covering injuries from October 2012 through September 2023. Those states account for more than 80% of workers' compensation benefits paid.
The study's main finding is reassuring, but its details offer a more practical lesson for those coordinating treatment.
What the study found
Closures changed where care happened
The study identified 343 hospital closures nationwide between 2010 and mid-2025, including 146 in rural areas. When a rural hospital closed, injured workers in the area traveled farther for emergency care. The share receiving emergency care on the day of injury fell by 3.6 percentage points. Where the next available hospital was at least 20 additional miles away, that share fell by 13.6 percentage points representing a 45% relative decrease in emergency care use.
Care did not disappear. It moved. After rural closures, more injured workers received office-based evaluation and management visits, and fewer first visits for evaluation or physical medicine took place in hospital settings. Rural workers traveled an average of 1.8 miles farther to their first evaluation and management visit, and the time between injury and first medical care changed very little.
Claim costs and disability duration held steady
Rural closures had little effect on medical payments per claim, indemnity payments per claim or the duration of temporary disability. Urban closures showed no meaningful effect. The report attributes part of that stability to care shifting into nonhospital settings, which are typically lower cost, along with onsite clinics, occupational medicine and urgent care relationships, nurse triage lines and telemedicine.
In the report's words, closures "primarily affect where care is accessed rather than whether the care is ultimately received by workers." WCRI recommends targeted interventions to address access gaps rather than broad concern about declining care quality.
Why distance still deserves attention
Average results describe the system. Individual claims are not averages.
One of the study's most striking figures has nothing to do with closures. Even before any closure, the most distant 10% of rural injured workers traveled more than 60 miles for their first major surgery, neurological testing or pain management injection. For those workers, distance was already part of the treatment plan.
A 60-mile trip is not simply a longer version of a 10-mile trip. It changes the questions that need answers before the appointment:
Can the injured worker drive there and back? After surgery, an injection or any procedure involving sedation, the answer is often no, whatever the distance. A mileage reimbursement plan that works for a routine follow-up may not work for this visit.
Does a same-day round trip make sense? An hour or more of driving each way, added to check-in, the procedure and recovery, can make for a long day. For some appointments, an overnight stay is the safer plan.
Who is available to help? A family member who can manage a short drive may not be able to give up a full day for every visit, especially when treatment involves a series of appointments.
Will language support be in place where the care is? A specialist in a smaller community may have fewer qualified interpreters nearby. Confirming the format, whether onsite, video or telephone, and arranging it ahead of time keeps a long trip from ending in a visit the injured worker cannot fully follow.
How will mileage be handled? Longer trips raise the stakes of reimbursement accuracy, whether the worker drives and submits mileage or the trip is arranged as a transportation service.
None of these questions is new. What the research makes clear is that as rural hospitals close, more injured workers will face them, and more of their care will take place in clinics and outpatient settings that may not be in their own town.
The appointment is only as reliable as the trip
One way to read the study's stable cost and duration findings is that the system adapts. Providers, claims professionals and injured workers find ways to get treatment completed. That adaptation is real work, and it happens one referral at a time: a confirmation call, a rescheduled ride, an interpreter booked for the right format, an overnight stay that keeps a long trip from becoming a missed appointment.
That is the part of recovery Transcom focuses on. Transportation and language services in workers' compensation are all we do. When an appointment means traveling farther, our team coordinates the connections, including flights and rail, hotels and lodging and ground transfers, with the injured worker's mobility and language needs in mind. We confirm appointment details and check in on the day of service to help keep plans on track.
Questions to ask at referral when care is far from home
What is the round-trip distance, and how long will the appointment and recovery take?
Will the injured worker be able to drive safely after this appointment?
Is a same-day return realistic, or would lodging be the better plan?
Does the injured worker need wheelchair, stretcher or other mobility support?
Is language support needed, and in what format?
If the appointment changes, who needs to know, and how quickly?
Hospital closures make headlines. The logistics that follow rarely do. For an injured worker who lives an hour from the nearest specialist, those logistics decide whether an appointment is kept or treatment is delayed.
Source: Workers Compensation Research Institute, Impact of Hospital Closures on Access to Care and Claim Outcomes, by Bogdan Savych and Olesya Fomenko (April 2026). Detailed figures as reported in WCRI's release and in Risk & Insurance coverage of the study (May 18, 2026). This article is provided for general information and is not legal or medical advice.