Hart L G, Amundson B A, Rosenblatt R A
Department of Family Medicine, University of Washington, Seattle 98195.
J Rural Health. 1990 Apr;6(2):101-18. doi: 10.1111/j.1748-0361.1990.tb00194.x.
Rural hospitals represent almost half of all short-stay nonfederal general hospitals in the United States, but have been more severely affected than their urban counterparts by changes in reimbursement, regulation, and technology. Two hundred and six rural community hospitals closed during the first nine years of the 1980s, and the rate of closure is accelerating. Using secondary data sources to examine the structure, role, and content of rural hospitals, small rural hospitals are described and compared to larger and nonrural hospitals. Rural hospitals differ systematically from other hospitals in the United States, with smaller daily censuses, lower occupation rates, shorter lengths of stay, and disproportionately high shares of Medicare patients. They are dominated by very small institutions, with more than 1,000 rural hospitals having fewer than 50 beds. Small rural hospitals offer a core of basic services to the populations they serve. Emergency, obstetric, and newborn services are virtually ubiquitous in rural hospitals of all sizes, and they are also more likely to offer long-term nursing and home care services than urban hospitals of similar size. The inpatient diagnostic and procedural mix of these institutions demonstrates that they provide care for common medical and surgical conditions of low complexity. Rural hospitals are also relatively inexpensive, representing only 6 percent of total expenditures for hospital care. Given their central role in supporting the provision of health services to rural areas, the apparent appropriateness of the conditions they treat, and their relatively modest cost, it would seem reasonable to use federal policy to stabilize our previous investment in these institutions.
乡村医院占美国所有非联邦短期综合医院的近一半，但在报销、监管和技术变革方面，它们比城市医院受到的影响更为严重。在20世纪80年代的头九年里，有206家乡村社区医院关闭，而且关闭速度正在加快。利用二手数据源来研究乡村医院的结构、作用和内容，对小型乡村医院进行了描述，并与大型和非乡村医院进行了比较。美国的乡村医院与其他医院存在系统性差异，日普查人数较少、占用率较低、住院时间较短，医疗保险患者的比例过高。它们以非常小的机构为主，超过1000家乡村医院的床位少于50张。小型乡村医院为其服务的人群提供一系列核心基本服务。急诊、产科和新生儿服务在各种规模的乡村医院中几乎无处不在，而且与类似规模的城市医院相比，它们也更有可能提供长期护理和家庭护理服务。这些机构的住院诊断和程序组合表明，它们为低复杂性的常见医疗和外科疾病提供护理。乡村医院的成本也相对较低，仅占医院护理总支出的6%。鉴于它们在支持向农村地区提供卫生服务方面的核心作用、它们所治疗疾病的明显适宜性以及相对适度的成本，利用联邦政策来稳定我们先前对这些机构的投资似乎是合理的。
