Rural hospital affiliation may come at a cost of critical services, study finds

Rural hospitals that affiliate with health systems may see their finances improve, but affiliation may also force them to cut critical services, according to a new study published in the December edition of Health Affairs.

For the study, researchers from the nonprofit Rand Corp. reviewed data to understand the effects of affiliation on rural hospitals and their patients. They used the American Hospital Association annual surveys for 2008–17 to compare rural hospitals that affiliated with a health system during that period and a propensity score–weighted set of rural hospitals that did not affiliate. Affiliating and nonaffiliating hospitals were compared on 12 measures of structure, utilization, financial performance and quality.

Researchers said affiliating hospitals' operating margins increased by 1.6 to 3.6 percentage points in the first two to five years after affiliation. At the same time, rural hospitals experienced a significant reduction in on-site diagnostic imaging technologies, the availability of obstetric and primary care services and outpatient nonemergency visits after affiliation, according to the study. Researchers did not find a significant difference in quality measures when comparing affiliating and nonaffiliating hospitals.

"Our findings raise concerns that health system affiliation could lead to reduction in access to care in rural areas," the study authors concluded. "Health systems should invest in systems and processes such as telehealth that reduce the travel burden on patients, offer convenient hours and transportation to accommodate patients from remote areas, and promote care coordination and medical record interoperability with remaining community providers."

Researchers also said policymakers should work to alleviate negative consequences of affiliation in places where it has already occurred.  

The study authors note that the research has some limitations, including that affiliation may have different meanings in different healthcare organizations, and that the American Hospital Association uses several different sources to determine hospital affiliation status.

 

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