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

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


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.

Publication types

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

MeSH terms

  • Aged
  • Health Services Accessibility*
  • Hospitals, Rural
  • Hospitals, Urban
  • Humans
  • Medicare*
  • Rural Population
  • United States