21st Century Rural Hospital: Outpatient Services and Access to Care

Lead researcher:
Project funded:
September 2012
Project completed:
March 2015
The services rural hospitals provide have changed dramatically over the past decades as they have expanded to provide outpatient services that are both needed by their communities and that support their financial viability. In this study we will explore how rural hospitals have adapted to meet the realities of 21st century healthcare and answer the following questions: What key factors influence how hospitals determine which outpatient services to provide and what services are offered? How do services differ by level of rurality, by type of reimbursement and other hospital characteristics, and by population characteristics? How would policy change affect availability of outpatient services?

This cross-sectional study has three phases:

  • In Phase 1 semi-structured interviews with hospital officials will focus on factors influencing the provision of outpatient care.
  • In Phase 2 using secondary data sources such as Medicare outpatient claims data, the OSCAR Provider of Service, Healthcare Cost Report Information System, US Census, Rural Health Clinic lists, and directories of specialized outpatient services we will determine to what extent rural hospitals have added outpatient services and characterize hospitals along several dimensions including services offered, community demographics, and financial condition.
  • In Phase 3 we will simulate the impact of a potential policy change, including both possible effects on rural hospitals and on the availability of outpatient services. Products will include the hospital database, a Policy Brief, and a 21st Century Rural Hospital Primer, with data tables and graphs, categorizing hospitals along multiple dimensions as well as documenting how key service-related characteristics such as demand, reimbursement, and staffing/equipment needs affect availability of outpatient services.


  • The 21st Century Rural Hospital: A Chart Book
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2015
    This chartbook presents a broad profile of rural hospitals and includes information on location, who they serve, services they provide, how they ensure outpatient services for their communities, other community benefits they provide, and financial performance. Each page includes charts comparing rural hospitals to each other and to urban hospitals.