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. 2022 Oct;57(5):1029-1034.
doi: 10.1111/1475-6773.14017. Epub 2022 Jul 13.

Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals

Hannah R Friedman  1   2 , George Mark Holmes  1   2
Affiliations

Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals

Hannah R Friedman et al. Health Serv Res. 2022 Oct.

Abstract

Objective: To determine whether rural Medicare FFS beneficiaries are more likely to be admitted to an urban hospital in 2018 than in 2010.

Data sources: We combined data from the 2010 to 2018 Hospital Service Area File (HSAF) and the 2010-2017 American Hospital Association (AHA) survey.

Study design: We conducted a fixed-effects negative-binomial regression to determine whether urban hospital admissions from rural ZIP codes were increasing over time. We also conducted an exploratory geographically weighted regression.

Data collection: We transformed the HSAF data into a ZIP code-level file with all rural ZIP codes. We defined rural as having a Rural-Urban Commuting Area (RUCA) code ≥4. A hospital's system affiliation status was incorporated from the AHA survey.

Principal findings: Controlling for distance to the nearest hospitals, an increase of 1 year was associated with a 2.0% increase (p < 0.001) in the number of admissions to urban hospitals from each rural ZIP code. New system affiliation of the nearest rural hospital was associated with an increase of 1.7% (p < 0.001).

Conclusions: Even when controlling for distance to the nearest rural hospital (which reflects hospital closures), rural patients were increasingly likely to be admitted to an urban hospital.

Keywords: Medicare; geographic/spatial factors/small area variations; health care organizations and systems; hospitals; rural health.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Conceptual model: drivers of patient care‐seeking behaviors [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Urban hospital admissions from rural ZIP codes, 2010 and 2018 [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. Malone T, Holmes M. Patterns of hospital bypass and inpatient care‐seeking by rural residents. NC Rural Health Research Program. 2019.
    1. Malone TL, Pink GH, Holmes GM. Decline in inpatient volume at rural hospitals. J Rural Health. 2020;37:347‐352. doi: 10.1111/jrh.12553 - DOI - PubMed
    1. Matthews JE. Ensuring access to emergency services for Medicare beneficiaries in rural communities. Medicare Payment Advisory Commission (MedPAC). 2018.
    1. Abrams K, Balan‐Cohen A, Durbha P. Growth in outpatient care: the role of quality and value incentives. Deloitte. 2018.
    1. Hung P, Kozhimannil KB, Casey MM, Moscovice IS. Why are obstetric units in rural hospitals closing their doors? Health Serv Res. 2016;51(4):1546‐1560. doi: 10.1111/1475-6773.12441 - DOI - PMC - PubMed

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