Changes in Provision of Selected Services by Rural and Urban Hospitals Between 2009 and 2017


During the past decade, access to healthcare services provided by rural hospitals has changed in two major ways. First, there has been a substantial increase in the number of rural hospitals that have closed or converted (provide some healthcare services but not inpatient care). Secondly, and less understood, many rural hospitals have reduced or terminated services historically considered to be essential hospital services. The purpose of this study is to gain a better understanding of recent trends in hospital service provision and whether there were disparities between rural and urban hospitals. This brief describes and compares the changes in service provision for rural and urban hospitals between 2009 and 2017.

Hospitals that responded for each service question in both 2009 and 2017 were identified from the American Hospital Association (AHA) Annual Survey Databaseā„¢. Hospitals were categorized as either rural or urban. Researchers selected 11 hospital services for the study (obstetrics, general surgery, emergency department, home health, labor and delivery, skilled nursing, hospital-based outpatient, orthopedic, oncology, emergency psychiatric services, and chemotherapy).

  • The percentage of rural hospitals that provided skilled nursing, obstetrics, labor and delivery, and home health services declined between 2009 and 2017.
  • The percentage of rural hospitals that provided orthopedic services, oncology services, hospital-based outpatient services, emergency psychiatric services, and chemotherapy services increased between 2009 and 2017.
  • Substantial differences in trends were observed between rural and urban hospitals. Across all selected services, there were no declines in the percentage of urban hospitals providing a service, with most services expanding in urban hospitals.

Ultimately, it is important to understand what services are available in rural areas and the reasons why rural hospitals are reducing or eliminating services. For example, insufficient reimbursement, low patient volumes, and workforce shortages are likely important in explaining hospital decisions about provision of services. A better understanding of the varying availability of services could inform policymakers and help target solutions to improve access to needed services.

North Carolina Rural Health Research and Policy Analysis Center
Kathleen Knocke, George Pink, Kristie Thompson, Randy Randolph, Mark Holmes