Affiliations raise risk of closure for some rural hospitals, study finds

A new study published by JAMA Health Forum suggests that affiliation between hospitals or multihospital systems may protect some financially distressed rural hospitals from closure, but could raise the risk of closure for those that are already financially stable.

The report details findings from a 13-year cohort study among the rural U.S. hospitals that faced financial distress in 2007. Among 2,237 rural hospitals operating in 2007, 140 (6.3 percent) had closed by 2019. The number of independent hospitals decreased from 68.9 percent in 2007 to 47 percent in 2019, and the proportion that were affiliated increased from 31.1 percent to 46.7 percent. 

Cohort findings suggest that affiliations may be associated with a lower risk of closure for some rural hospitals in financial distress. However, among initially stable hospitals, affiliation and proprietary ownership raises concerns about closures in some circumstances. 

The increase in rural hospital closures has strained access to inpatient care in some rural communities. 

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