Association Between Rural Hospital Service Changes and Community Demographics


The loss of local hospital services can reduce access to needed care. Continuing our research on changes in hospital services, we investigated whether certain Agency for Healthcare Research and Quality (AHRQ) priority populations in rural communities, as defined by larger county median percentages of Hispanic/Latino residents, non-Hispanic Black residents, residents aged 65 years or older, or residents in poverty, were more likely to lose important hospital-based services from 2011-2017.

The purpose of this brief was to investigate the association between the proportion of a rural community belonging to an AHRQ-identified priority population and local hospital service changes. Our results suggest that recent trends in service availability are often similar when comparing hospitals in non-metro counties with larger versus smaller priority populations. In aggregate, from 2011-2017, hospitals in non-metro counties generally experienced a net decrease in the availability of obstetric services and skilled nursing services and a net increase in the availability of oncology services, hospital-based outpatient services, orthopedic services, and emergency psychiatric services. Aggregate changes in the availability of home health and chemotherapy were generally smaller in magnitude. These aggregate results are consistent with previous work on rural hospital-based service availability.

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