Effect of Rural Hospital Consolidation on Patient Distance to Specialty Services

Hospital closures, conversions, and mergers have raised concerns about patient and community access to care, yet little is known about how consolidation affects the availability of hospital service lines and spatial access to specialty services. Because service lines vary in profitability, consolidation may disproportionately reduce access to lower-margin services such as obstetrics, primary care, and substance use treatment. These effects are especially consequential in rural areas, where hospitals serve smaller populations, face higher rates of uninsurance, and manage greater burdens of chronic illness.

This study examines whether rural residents' spatial access to specialty service lines changes following consolidation of their local hospital. We ask whether certain services are more likely to be added or eliminated after consolidation events and how such changes affect patient travel distance to care. We hypothesize that consolidation-related changes will have the greatest impact in rural areas with limited hospital choice, where patients must travel farther to bypass their nearest hospital. Prior evidence suggests that access to obstetric and neonatal services already varies by insurance status and area-level socioeconomic conditions; consolidation may exacerbate these disparities.

We will identify rural hospital consolidation events using RAND and AHRQ System Compendium data and track changes in service line availability using CMS cost reports and the American Hospital Association Annual Survey. Hospital locations from the CMS Provider of Services file will be geocoded and linked to service line data. Using ZIP Code Tabulation Area–level measures from approximately 2010–2023, we will assess changes in geographic access to hospitals offering specialty services. The primary outcome is change in travel distance to the nearest hospital with a given service line, and the key independent variable is whether the nearest hospital experienced consolidation in prior year(s).

By quantifying how hospital consolidation affects spatial access to specialty care, this study addresses a critical gap at the intersection of rural population health and rural health systems and informs policies aimed at preserving equitable access to essential hospital services.