One of the Health Resources and Services Administration's strategic goals is to address the closure of rural hospitals. But in addition to wholesale closures, rural hospitals are changing the portfolio of services they offer. Decreases in the essential services offered by rural hospitals can exacerbate rural-urban health disparities that already exist. To date, few studies have examined risk factors that predict changes in services offered by rural hospitals. A study in Health Services Research in 2011 found that nonprofit and public rural hospitals were more likely to offer unprofitable services than their for-profit counterparts.

Additionally, hospital characteristics such as financial health and demographics of the surrounding population have been linked to risk of hospital closure, but the association between hospital size, region, rurality, or type and available services has not been well established. Furthermore, long-term trends in the rural availability of essential services such as oncology, home health, and psychiatric services have not been fully explored. Identifying declining services and the risk factors for service changes can lead to targeted solutions that assist struggling hospitals with the maintenance of important service offerings.

The purpose of this study was to compare the services offered by rural hospitals to urban hospitals over time (2009-2017) and among rural hospitals of various sizes, regions, rurality, and payment types. Rural residents typically have worse access to healthcare compared to their urban counterparts. Understanding the risk factors for closing services in rural hospitals can (1) inform efforts to ensure continuous access to necessary healthcare services, (2) prevent rural-urban access disparities from increasing, and (3) help preserve the economic viability of the hospital and potentially the community.

Publications

• Association Between Rural Hospital Service Changes and Community Demographics
  Policy Brief
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 05/2022
  Research has shown that among rural communities, those with a larger percentage of Black or Hispanic residents were more likely to experience a local hospital closure. This brief explores possible associations between the proportion of a rural community belonging to a AHRQ-identified priority population and local hospital service changes.
• Changes in Provision of Selected Services by Rural and Urban Hospitals Between 2009 and 2017
  Policy Brief
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 04/2021
  The purpose of this study is to gain a better understanding of recent trends in hospital service provision and whether there were disparities between rural and urban hospitals. This brief describes and compares the changes in service provision for rural and urban hospitals between 2009 and 2017.
• Changes in the Provision of Health Care Services by Rural Critical Access Hospitals and Prospective Payment System Hospitals in 2009 Compared to 2017
  Policy Brief
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 08/2022
  The purpose of this brief is to explore changes in the availability and provision of different health care services among rural CAHs and PPS hospitals in 2009 compared to 2017.