That’s the subject of a commentary by Carroll et al. (2022) in Well being Companies Analysis. The primary situation they focus on is entry to care.
A core problem in rural communities is declining entry to hospital care. Eight % of rural hospitals have closed over the past decade, and closure charges have elevated lately.8 Even hospitals that stay open are downsizing and shutting particular person service strains. Solely 40% of rural counties had obstetric providers in 2018, for instance, down from 55% in 2004 and 75% within the 1980…obstetric unit closures have disproportionately affected rural communities with a better proportion of Black residents, these in additional distant areas, and in states with much less beneficiant state Medicaid applications.
Offering entry isn’t really easy. Rural areas, by definition, have low affected person density close by and decrease affected person volumes results in decrease income and better value per affected person as capital prices are unfold over fewer sufferers. A examine by Hegland et al. (2022) finds that:
…rural hospital markets have extra mattress capability per capita and decrease occupancy charges than city areas however much less entry to different hospital assets equivalent to capital funding and staffing
Rural hospitals aiming to extend revenues could intention to extend mattress occupancy, however the one manner to do that in rural areas sometimes includes rising affected person transportation time to the hospital. These longer transportation occasions, nonetheless, could result in worse outcomes, notably for when remedy is required for time-sensitive circumstances.
One key level to make is that not all rural hospital closures are unhealthy. Whereas transportation occasions could enhance,
…if hospitals that shut have a tendency to offer low-quality care, then closure could enhance well being outcomes by reallocating sufferers to increased high quality services.
One other influence of rural hospital closures are that they could influence the entire native economic system as hospitals are sometimes main employers in rural areas. Nonetheless, supporting employment isn’t a cause to maintain open a hospital that’s not offering high-quality care.
Rural hospitals additionally face challenges from a shifting market. Two developments particularly that characterize challenges embody:
…consolidation (a supply-side phenomenon whereby hospitals merge or change possession) and bypass (a demand-side phenomenon whereby rural residents don’t search care at native rural hospitals, “bypassing” them in favor of touring to city hospitals).
Consolidation of rural hospitals into programs has elevated over time. About 11% of rural hospitals merged between 2005 and 2016…
[Regarding bypass,] a 3rd of Medicare inpatient stays weren’t at beneficiaries’ closest hospital in 2018, even when providers have been obtainable at these closest hospitals. A key query is how a lot bypass has contributed to total decreases in rural hospital quantity. Friedman and Holmes…argue that will increase in bypass over time clarify extra of the general quantity lower than declines in inhabitants or shifts towards outpatient care
The article concludes with a number of key coverage questions:
- What varieties of hospital providers must be maintained domestically and what varieties of providers must be offered regionally?
- Ought to rural hospitals be subsidies and in that case how a lot monetary assist is warranted?
- What well being fairness methods must be employed for rural hospitals?
- Ought to rural hospitals take part extra (or much less) in various fee fashions linking care to high quality?
Total, the commentary supplies a pleasant overview of the problems going through rural hospitals. Learn the entire article right here.