The primary purpose of this research was to assess changes in availability of hospital services in communities following affiliation of the local hospital with a regional or national system. While there is considerable research underway focused on financing implications for local hospitals and systems, there is much less attention given to how service offerings change over time after a previously independent hospital becomes part of a regional system. Federal and state policies designed to assure reasonable access to services (network adequacy regulations in the Medicare program, state regulations of insurance offerings) and programs designed to assure access (such as targeting obstetric services) will benefit from understanding the dynamics of changes in service offerings resulting from post-affiliation (including merger and acquisition) decisions of regional systems.

Hypotheses: 1) Services offered (measured using indicators in the AHA survey) will change in rural hospitals after becoming part of regional systems as compared to hospitals not in systems; and 2) Regional systems will, over time, implement strategies to consolidate service lines in member hospitals based on capacity of hospitals, meeting network adequacy standards, and system finances.

Publications

• Changes in Service Offerings Post-System Affiliation in Rural Hospitals
  Policy Brief
  RUPRI Center for Rural Health Policy Analysis
  Date: 01/2023
  This policy brief aims to understand the range of effects on service offerings after rural hospitals become part of, or leave, a regional or national healthcare system.