A Closer Examination of Rural Hospital Bypass

When rural residents leave their community for care that is available in their community (hospital bypass), the local hospital's financial condition may be adversely impacted, ultimately impairing access to care in the community. This project estimated the rural hospital bypass rate using all-payer claims data for a set of states and compared patients based on the inpatient treatments and procedures received relative to those routinely provided by rural facilities.

Analysis estimated all-payer (all-insurance types) inpatient bypass rates for rural hospitals using 2018 data. Bypass was defined by comparing inpatient residence and the hospital service area within which the patient resides. Regression models, specified based on hypotheses and findings derived from the current bypass literature, identified factors associated with hospital-level bypass rates. Factors included hospital characteristics, such as patient mix and characteristics of the hospital service area including rurality. Logistic regression modeling examined the probability of bypass at the inpatient stay level. Following the reviewed literature, factors hypothesized to affect the inpatient's bypass decision included the patient's health status, and hospital and community characteristics.

Publications

• An Examination of All-Payer Inpatient Rural Hospital Bypass
  Policy Brief
  ETSU/NORC Rural Health Research Center
  Date: 03/2026
  This policy brief examines inpatient rural hospital bypass in eight states and finds that 30 percent of rural patients received care outside their local hospital for services available nearby. It highlights patterns by payer, admission type, and hospital type, and the implications for rural hospital viability.