In 2016, the Kaiser Commission on Medicaid and the Uninsured, in conjunction with the Urban Institute, conducted a case study analysis of three privately owned Southern hospitals to determine the causes and effects of their closures in Kansas, Kentucky and South Carolina. In addition to the challenges of graying, declining and poverty-stricken populations, as well as the preference of privately insured patients to seek treatment at newer hospitals further away, the report said corporate profit-driven decisions, as opposed to local community needs, shuttered the doors of rural hospitals in underserved areas. In a "shift from mission to margin," health systems that owned multiple hospitals, some more profitable than others, closed less-profitable hospitals in Kentucky and South Carolina to concentrate resources on other hospitals in the chain, resulting in communities without acute care and emergency facilities to serve as a safety-net for patients facing challenges with mental health and drug use. The case studies report also notes that decreases in Medicare and Medicaid reimbursements, some the result of federal budget sequestration or across the board cuts, others the result of the Affordable Care Act's lower hospital Medicare readmission reimbursement rates, negatively impacted the finances of the rural hospitals.
