What Does Healthcare Delivery System Reconfiguration Portend for Rural Health?

Research center:
Lead researcher:
Project funded:
September 2016
Project completed:
November 2018

The purpose of this project was to understand the dynamic relationships between healthcare system changes and healthcare network configurations that involve rural providers. Recent healthcare system changes include regional provider network expansions (through merger, acquisition, affiliation, and other alignment strategies), value-based payments (that incent new organizational and care delivery design), new demands for clinical quality performance and reporting, additional costs associated with information and other technologies, and policies designed to assure access to essential services. Our research focus was twofold:

  1. Characterize the provider network strategies that best serve rural populations.
  2. Identify the options rural providers should assess when considering network affiliation.


  • The Rural Hospital and Health System Affiliation Landscape – A Brief Review
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2018
    The shift from traditional fee-for-service to value-based payment requires major capital investment. In this paper, we examine rural hospital and health system motivations for affiliation and present a non-exhaustive list of common affiliation structures with representative examples.
  • Trends in Hospital System Affiliation, 2007-2016
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2018
    This policy brief updates a RUPRI Center brief published in 2014 and documents the continued growth in system affiliation by both metropolitan and non-metropolitan hospitals.