Orewa Gregory N, Pradhan Rohit, Ghiasi Akbar, Gupta Shivani, Weech-Maldonado Robert
Department of Public Health & Department of Management, College of Health, Community, and Policy & Carlos Alvarez College of Business, University of Texas at San Antonio, San Antonio, Texas, USA.
School of Health Administration, Texas State University, San Marcos, Texas, USA.
J Rural Health. 2025 Jun;41(3):e70053. doi: 10.1111/jrh.70053.
The financial sustainability of nursing homes is increasingly critical as the aging US population continues to grow. Rural facilities often encounter more significant economic challenges than urban counterparts. This study investigates the disparities in financial performance between rural and urban nursing homes in the United States, emphasizing the influence of organizational and environmental factors. A comprehensive understanding of these differences is necessary for the implementation of effective policy and management interventions.
The study used a longitudinal dataset (2018-2022) comprising 66,056 nursing home-year observations. Data sources included Centers for Medicare and Medicaid Services (CMS) Cost Reports, Payroll-Based Journal, Care Compare, LTCFocus, and the Area Health Resource File. The dependent variable was the operating margin. The primary independent variable, geographic location, was classified using Rural-Urban Commuting Area (RUCA) codes. We conducted multivariable linear regression with facility-level random effects and two-way fixed effects (state and year) to assess rural-urban financial disparities while controlling for organizational and environmental factors and the impact of COVID-19.
Rural nursing homes had lower operating margins than urban facilities in unadjusted models. However, after adjusting for organizational factors such as size, occupancy, and payer mix, the rural-urban difference was no longer significant. Environmental factors, including population demographics and income levels, contributed to financial disparities. COVID-19 exacerbated financial challenges, disproportionately affecting rural facilities.
Financial disparities between rural and urban nursing homes are not solely due to geographical location, but also stem from structural challenges. These insights have significant policy implications suggesting that addressing reimbursement rates, operational efficiency, and resource allocation is crucial to ensure the financial sustainability and quality care for aging populations.
随着美国老年人口持续增长，养老院的财务可持续性愈发关键。农村养老院往往比城市养老院面临更严峻的经济挑战。本研究调查了美国农村和城市养老院在财务绩效方面的差异，强调组织和环境因素的影响。全面了解这些差异对于实施有效的政策和管理干预措施至关重要。
该研究使用了一个纵向数据集（2018 - 2022年），包含66,056个养老院年度观测值。数据来源包括医疗保险和医疗补助服务中心（CMS）成本报告、基于工资的日志、护理比较、长期护理聚焦以及地区卫生资源文件。因变量是营业利润率。主要自变量地理位置使用城乡通勤区（RUCA）代码进行分类。我们进行了具有机构层面随机效应和双向固定效应（州和年份）的多变量线性回归，以评估城乡财务差异，同时控制组织和环境因素以及新冠疫情的影响。
在未调整的模型中，农村养老院的营业利润率低于城市养老院。然而，在调整了诸如规模、入住率和付款人组合等组织因素后，城乡差异不再显著。包括人口统计学和收入水平在内的环境因素导致了财务差异。新冠疫情加剧了财务挑战，对农村养老院的影响尤为严重。
农村和城市养老院之间的财务差异并非仅由地理位置造成，还源于结构性挑战。这些见解具有重要的政策意义，表明解决报销率、运营效率和资源分配问题对于确保老年人口的财务可持续性和优质护理至关重要。
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