Carroll Caitlin, Euhus Rhiannon, Beaulieu Nancy, Chernew Michael E
Caitlin Carroll (
Rhiannon Euhus, Harvard University, Boston, Massachusetts.
Health Aff (Millwood). 2023 Apr;42(4):498-507. doi: 10.1377/hlthaff.2022.01191.
Financial distress among rural hospitals in the US has increased in recent years. Using national hospital data, we investigated how the decline in profitability has affected hospital survival, either independently or with a merger. The answer has direct implications for access to care and competition in rural markets. We assessed the rate of hospital closures and mergers in predominantly rural markets during the period 2010-18, focusing on hospitals that were unprofitable at baseline. A minority of unprofitable hospitals (7 percent) closed. A larger share (17 percent) merged, most commonly with organizations from outside of their local geographic market. Most unprofitable hospitals (77 percent) continued to operate through 2018 without closure or merger. About half of these hospitals returned to profitability. At the market level, 22 percent of markets served by unprofitable hospitals lost a competitor to closure or within-market merger. Out-of-market mergers affected 33 percent of markets with an unprofitable hospital. Overall, our results suggest that rural markets are experiencing meaningful rates of hospital closures and mergers, yet many hospitals have survived despite poor financial performance. Policies targeting access to care will continue to be important. Similar attention will be needed to address the competitive effects of hospital closures and mergers on prices and quality.
近年来，美国农村医院的财务困境有所加剧。我们利用全国医院数据，研究了盈利能力下降是如何独立地或通过合并影响医院生存的。这一答案对农村市场的医疗服务可及性和竞争具有直接影响。我们评估了2010年至2018年期间主要农村市场的医院关闭和合并率，重点关注基线时无盈利的医院。少数无盈利的医院（7%）关闭了。更大比例（17%）进行了合并，最常见的是与当地地理市场以外的组织合并。大多数无盈利的医院（77%）在2018年之前继续运营，没有关闭或合并。这些医院中约有一半恢复了盈利。在市场层面，由无盈利医院服务的市场中有22%因关闭或市场内合并而失去了一个竞争对手。市场外合并影响了33%有无盈利医院的市场。总体而言，我们的结果表明，农村市场正在经历有意义的医院关闭和合并率，然而许多医院尽管财务表现不佳仍得以生存。针对医疗服务可及性的政策将继续重要。同样需要关注医院关闭和合并对价格和质量的竞争影响。
