Changes in Care‐Seeking after Rural Hospitals Merge

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Rural hospital mergers have increased significantly since 2010. Enhanced financial performance and improved quality are often cited as benefits, but hospital mergers can also lead to changes in the services provided by acquired hospitals. This brief estimates the use of inpatient services delivered by acquired rural hospitals following a merger.


The NC Rural Health Research Program, in the brief, Changes in Care Seeking after Rural Hospitals Merge, examined 15 rural hospitals that were acquired as part of a merger between 2014 and 2016. Among these hospitals, our main finding was that the overall bypass rate for inpatient care showed little change between the 15 months prior to the merger and the 15 months following the merger (bypass was defined as any nontransfer inpatient discharge of a rural resident from a hospital other than the hospital located nearest to the centroid of the patient’s ZIP‐based residence). The overall bypass rate consistently ranged between 63‐66%. There is variation for specific conditions, however. Acquired rural hospitals were less likely to be bypassed for inpatient care pertaining to the respiratory system and mental diseases and disorders (e.g., psychoses). There is some evidence to suggest that changes in bypass rates following a merger are influenced by service profitability.