Patterns of Hospital Bypass and Inpatient Care-Seeking by Rural Residents

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Hospital bypass, the tendency of local rural residents to not seek care at their closest hospital, is thought to be a contributing factor for rural hospital closure. To to update the knowledge base of determinants of bypass behavior, the NC Rural Health Research Program produced the brief, Patterns of Hospital Bypass and Inpatient Care‐Seeking by Rural Residents. We analyzed 2014-2016 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) from the following states: Arizona, Colorado, Florida, Iowa, Kentucky, Minnesota, North Carolina, Nebraska, New Jersey, New York, Oregon, Utah, Vermont, Washington, and Wisconsin.

Our results suggest that inpatient bypass behavior is driven by both hospital-level and patient-level characteristics. In comparison to other rural hospitals, rural hospitals are more likely to be bypassed by local residents if they are: a Critical Access Hospital, smaller, less profitable, and do not offer obstetric service.  Individuals that did not bypass their local rural hospital were more likely to belong to vulnerable populations (e.g., adults age 65 and over, racial and ethnic minorities, individuals with public insurance, individuals living in frontier and remote areas). Thus, these results continue to highlight the importance of local rural hospitals as a source of care for vulnerable populations and the potential effect of inpatient bypass behavior on rural hospital closures. Future research can build on this study by considering the determinants of outpatient bypass behavior and its possible effects on rural hospitals.