RALEIGH -- Now is a challenging time for rural hospitals as economics, especially reimbursement rates from government health care programs, is making it harder for them to keep their doors open.

That view from Bill Pulley, the Executive Director of the North Carolina Hospital Association.

"I've been with the hospital association for thirty years. In the first 29 years we closed three hospitals in North Carolina. We've closed three this year."

One hospital that closed this year, in Belhaven was the subject of controvery. Some argued the state's refusal to take up the federal government's offer to expand Medicaid was partly the reason for the closure while others say it was a deliberate strategy by the owner to force patient to use a larger facility in Washington.