System affiliation may lead to an increase or decline in
the number of services offered in a local hospital. This
may have positive or negative effects for patients and
may change both access to care and quality of care. 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.
- Of the 62 service offerings examined in the study
period (2008 through 2020), researchers found more
substantive (with a change of 5-percentage points or
more) service line increases than decreases in rural
hospitals, with 23 services having substantive increases
and 10 services having substantive decreases.
- Changes in service offerings (either gains or losses)
occurred across all hospital types regardless of whether
the hospitals joined or left systems or were never or
always in a system.
- Compared with hospitals that were never or always in
a healthcare system, gains in healthcare services
occurred more frequently in hospitals that left systems
(35.4 percent), while the majority of service losses
occurred in hospitals that joined systems (46.2 percent).