Access To Obstetric, Behavioral Health, And Surgical Inpatient Services After Hospital Mergers In Rural Areas

Health Aff (Millwood). 2021 Oct;40(10):1627-1636. doi: 10.1377/hlthaff.2021.00160.


Despite rural hospitals' central role in their communities, they are increasingly in financial distress and may merge with other hospitals or health systems, potentially reducing service lines that are less profitable or duplicative of services that the acquirer also offers. Using hospital discharge data from thirty-two Healthcare Cost and Utilization Project State Inpatient Databases from the period 2007-18, we examined the influence of rural hospital mergers on changes to inpatient service lines at hospitals and within their catchment areas. We found that merged hospitals were more likely than independent hospitals to eliminate maternal/neonatal and surgical care. Whereas the number of mental/substance use disorder-related stays decreased or remained stable at merged hospitals and within their catchment areas, it increased for unaffiliated hospitals and their catchment areas, indicating a potential unmet need in the communities of rural hospitals postmerger. Although a merger could salvage a hospital's sustainability, it also could reduce service lines and responsiveness to community needs.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Health Care Costs
  • Health Facility Merger*
  • Hospitals, Rural
  • Humans
  • Infant, Newborn
  • Inpatients
  • Rural Population