Research Alert: March 19, 2026

An Examination of All-Payer Inpatient Rural Hospital Bypass

This policy brief examines inpatient rural hospital bypass in eight states using 2018 Healthcare Cost and Utilization Project State Inpatient Databases. The analysis draws on inpatient admissions for adults age 18 years and older in Arizona, Iowa, Kentucky, New York, North Carolina, Vermont, Washington, and Wisconsin, and defines local hospital service areas based on the ZIP codes accounting for a hospital's inpatient volume. These findings underscore the continuing importance of local hospital capacity and patient retention for rural access and hospital viability.

Key Findings:

• Within the eight included states, 30 percent of inpatient discharges were not at patients' local rural hospitals (hospital bypass) for services that could be provided locally.
• Patients more likely to bypass their local rural hospital included those admitted for elective conditions, with private insurance, and fewer comorbidities.
• Critical Access Hospitals experienced higher bypass rates than their Prospective Payment System counterparts in rural areas.

Additional Resources of Interest:

• More FORHP-funded research on Critical Access Hospitals (CAHs), Hospitals and clinics
• More information about the ETSU/NORC Rural Health Research Center
• More information from the Rural Health Information Hub's topic guide: Hospitals