Advocacy matters
Organizations, associations especially, advocate on a daily basis to support their members, communities, the environment, and more. Advocating in the face of legislators, stakeholders and the general public requires presenting information that matters for those audiences. Stakeholders, members, and legislators, may care about the economic benefits that a law, a cause or organization brings to them; the general public and legislators also may care about jobs created or supported by those initiatives.
Regardless of the impact organizations want to highlight to advocate for themselves and their initiatives, IMPLAN is a flexible platform for building the economic numbers that can support their cases. IMPLAN provides the tools to:
- Quantify the economic ripple effects of and their members’ operations.
- Measure impacts of future and current investments associated with their members.
- Provide economic evidence to policy-makers of how the initiatives they advocate for benefit the community.
Use case: The Economic Impact of Rural Hospital closures
Background
In the past 20 years nearly 200 hospitals located in remote areas of the US have been closed and more than 400 are at risk of closure currently (Bennett et al., 2026). At the same time, services offered by this type of hospital have declined considerably, causing the diversion of patients towards hospitals that are farther away, often in urban areas.
The United States has over 2,255 rural hospitals with average operating expenses of over $83 million dollars in 2025, with higher concentration in Texas, Kansas, Minnesota, Iowa, and Oklahoma. In order to analyze what would be the impact of closures we will concentrate on one of the states with one of the highest concentrations of rural hospitals, Oklahoma.
Figure 1 shows the rural and urban hospitals locations across Oklahoma, with higher concentration near urban hubs like Enid, Lawton, Tulsa and Oklahoma City. In addition to these clusters around urban hubs, this state has a large count of rural hospitals, of which it is reported that at least 45 are in risk of closure, alleging large dependence on Medicaid and Medicare payments.
Finances are another important characteristic of hospitals in this state. According to the data from the Center for Healthcare Quality and Payment Reform, a portion of Oklahoma’s hospitals run at a loss, with expenses exceeding revenue. This state has one of the largest cumulative losses across their hospitals. Oklahoma’s hospitals revenue is highly dependent on Medicare and Medicaid, with payments averaging 46% of their revenue. Therefore, changes in policies across these programs could greatly affect these hospital’s operations.
Rural hospital closures have been studied to understand reasons on why some are more vulnerable to closure than others. A 2026 report from the Office of the Assistant Secretary for Planning and Evaluation suggests adjacency to an urban county as one of the main reasons for closure.
For this article we chose five rural hospitals in Oklahoma that are:
- Not located in adjacent counties to main urban hubs but also not totally isolated from those urban hubs.
- Financially vulnerable based on revenue and expenses reported in the Center for Healthcare Quality and Payment Reform data and whose share of revenue from Medicare and Medicaid ranges from 36% to 70%.
For these rural hospitals, shown on the map in figure 2, we will model a hypothetical closure and quantify the ripple effects using IMPLAN.
Setting up our case study in IMPLAN
We will be modeling the five hospitals at the county level using their revenue per the data from the Center for Healthcare Quality and Payment Reform as a proxy for output. The total revenue for these hospitals accounts for almost $100 million dollars. For this analysis we will use Industry Output events in each county where the hospitals are located, In addition, we will include a custom, combined region for the rest of Oklahoma.
The event is applied in Industry 472 - Hospitals as a negative value, indicating a closure:
Alternatively, if the user knows the cost structure of the hospital(s) they wish to advocate for they can create a customized spending pattern. Finally, we run the analysis as an MRIO model to also assess the spillover effects of these hypothetical closures in the rest of the state.
Results
Besides the direct output reductions associated with these hospital revenues ($100 million), these closures contract total output through indirect effects in the hospital counties by $16 million, and $6 million across the rest of Oklahoma. The induced effects lost through the closures account for almost $25 million, 80% of which occurs in the five affected counties. Other effects of potential closures include loss of support for over 600 jobs, over half of which include jobs in affected hospitals.
If we look closely at the industries affected the most through the linkages with the hospital industry, we find that ‘Other real estate’ is the industry most impacted through indirect and induced effects, accounting for almost $6 million in potential output losses. Other industries affected through indirect and induced effects include employment services, full service restaurants and owner-occupied housing.
Finally, in terms of occupations as expected, the majority of occupations affected by a potential closure would be related to healthcare (healthcare practitioners, registered nurses, support occupations, health technologists). Some of the occupations not directly tied to healthcare that could be negatively impacted by these rural hospital closures include sales and related occupations, food preparation and serving related occupations, business and financial operations, and food and beverage serving workers.
Conclusion: Why is this analysis relevant?
Rural hospitals are economically relevant, not just healthcare providers. The five hypothetical closures modeled here would remove roughly $100 million in direct output, but the effects do not stop at the hospital doors as an additional $22 million in output would be lost through indirect and induced effects across Oklahoma, and more than 600 jobs would go unsupported with nearly half of them being outside of the hospitals themselves. There would be unsupported jobs in industries like real estate, restaurants, employment services and housing. Therefore, hospital closures cause a contraction across their value chain, both inside and beyond the counties they serve.
These hospitals can be affected through exposure linked to policy. These five hospitals draw between 36 to 70% of their revenue from Medicare and Medicaid. A loss of just Medicare and Medicaid related revenue yields over $50 million in reduction of output, with linearly lower effects in the same industries and occupations analyzed above.
This is where IMPLAN strengthens advocacy:
- It replaces a general claim that cuts will hurt with a concrete estimate of the jobs and output at stake.
- It lets an organization model the specific scenarios its members face including full closures, reimbursement reductions from Medicare and Medicaid changes, or the loss of healthcare workers in those rural areas.
- It converts proposed policy changes into tangible job and revenue numbers that advocates can bring straight to lawmakers.
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Hospitals: Modeling Private Hospital Impacts with Industry Impact Analysis
Hospitals: Modeling Public & Non-profit Hospital Impacts with Industry Impact Analysis
Written September 11, 2026