Risk of Closure Among Independent and Multihospital-Affiliated Rural Hospitals

Area of Science:

• Health Services Research
• Rural Health Policy
• Hospital Management

Background:

• Rural hospital closures threaten access to essential inpatient care.
• Understanding factors influencing rural hospital survival is critical for policy development.
• Hospital system affiliation is a key structural change for rural facilities.

Purpose of the Study:

• To investigate the association between hospital system affiliation and the risk of rural hospital closure.
• To determine if this association differs based on initial financial stability.
• To inform policy interventions aimed at maintaining rural healthcare access.

Main Methods:

• A national cohort study of US rural hospitals (2007-2019) using survival models.
• Time-dependent variable comparing affiliated vs. independent hospital status.
• Data sourced from American Hospital Association, Irving Levin Associates, and other national databases.

Main Results:

• Affiliation was linked to a lower closure risk for financially distressed rural hospitals (aHR, 0.49).
• Affiliation was linked to a higher closure risk for financially stable rural hospitals (aHR, 2.36).
• For-profit ownership also increased closure risk for financially stable hospitals (aHR, 4.08).

Conclusions:

• Hospital affiliation presents a complex relationship with rural hospital closure risk.
• Affiliation may protect vulnerable rural hospitals but could pose risks for others.
• Policy interventions must consider financial status and ownership when addressing rural hospital closures.