Rural Health
Resources by Topic: Health systems
The Impact of Rural Hospital Closures and Mergers on Health System Ecologies: A Scoping Review
Examines 46 studies on rural hospital closures and mergers between 2010 to 2023, with a focus on understanding health system impacts, finances, workforce, utilization, access to facilities and services, and community and economic well-being.
Author(s): Alison Coates, Janice Probst, Kanika Sarwal, Suhaib Riaz, Agnes Grudniewicz
Citation: Medical Care Research and Review, 82(5)
Date: 07/2025
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Examines 46 studies on rural hospital closures and mergers between 2010 to 2023, with a focus on understanding health system impacts, finances, workforce, utilization, access to facilities and services, and community and economic well-being.
Author(s): Alison Coates, Janice Probst, Kanika Sarwal, Suhaib Riaz, Agnes Grudniewicz
Citation: Medical Care Research and Review, 82(5)
Date: 07/2025
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Impact of Hospital Closure on Rural Communities: A Qualitative Study
Examines the impact of rural hospital closure on access to care, and identifies ways that rural communities adapt to hospital closures. Utilizes interview excerpts from 25 informants examining themes related to pre-closure conditions, impacts on communities and health systems, and actions by communities, states, health systems, and emergency medical services.
Author(s): Redwan Bin Abdul Baten, Mina Shrestha, Fred Ullrich, Whitney Zahnd, Keith J. Mueller
Date: 05/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Examines the impact of rural hospital closure on access to care, and identifies ways that rural communities adapt to hospital closures. Utilizes interview excerpts from 25 informants examining themes related to pre-closure conditions, impacts on communities and health systems, and actions by communities, states, health systems, and emergency medical services.
Author(s): Redwan Bin Abdul Baten, Mina Shrestha, Fred Ullrich, Whitney Zahnd, Keith J. Mueller
Date: 05/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Negotiated Prices for Care at Independent and System-Affiliated Rural Hospitals
Compares negotiated prices for procedural and imaging services at independent rural hospitals versus system-affiliated rural hospitals. Analyzes commercially negotiated price data with their associated hospital and evaluates number of negotiated prices for services. Discusses policies for rural hospital financial sustainability.
Author(s): Cody Lendon Mullens, Mitchell Mead, James D Lee, et al.
Citation: JAMA Network Open, 8(5)
Date: 05/2025
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Compares negotiated prices for procedural and imaging services at independent rural hospitals versus system-affiliated rural hospitals. Analyzes commercially negotiated price data with their associated hospital and evaluates number of negotiated prices for services. Discusses policies for rural hospital financial sustainability.
Author(s): Cody Lendon Mullens, Mitchell Mead, James D Lee, et al.
Citation: JAMA Network Open, 8(5)
Date: 05/2025
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Exercising Self-Governance Through an Indian Managed Care Entity: The Eastern Band of Cherokee Indians Tribal Option
Profiles the Cherokee Indian Hospital Authority (CIHA), a health system serving the Eastern Band of Cherokee Indians (EBCI). Discusses the design and impact of their Medicaid managed care entity.
Author(s): Anne Smithey, Rob Houston
Date: 03/2025
Sponsoring organization: Center for Health Care Strategies
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Profiles the Cherokee Indian Hospital Authority (CIHA), a health system serving the Eastern Band of Cherokee Indians (EBCI). Discusses the design and impact of their Medicaid managed care entity.
Author(s): Anne Smithey, Rob Houston
Date: 03/2025
Sponsoring organization: Center for Health Care Strategies
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The Potential for Hospital System Integration to Improve the Financial Outlook of Rural Hospitals in the United States
Provides an overview of the current financial status of rural hospitals and their risk of closure, as defined by days of cash on hand and total margins. Discusses the impact of rural hospital closures on local communities, including on health outcomes, demographics, and the economy. Explores the extent to which affiliating with, merging with, or being acquired by a larger hospital system can impact the financial position of rural hospitals.
Author(s): Al Dobson, Michael Beins, Patrick McMahon, et al.
Date: 11/2024
Sponsoring organizations: Coalition to Strengthen America's Healthcare, Dobson DaVanzo & Associates
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Provides an overview of the current financial status of rural hospitals and their risk of closure, as defined by days of cash on hand and total margins. Discusses the impact of rural hospital closures on local communities, including on health outcomes, demographics, and the economy. Explores the extent to which affiliating with, merging with, or being acquired by a larger hospital system can impact the financial position of rural hospitals.
Author(s): Al Dobson, Michael Beins, Patrick McMahon, et al.
Date: 11/2024
Sponsoring organizations: Coalition to Strengthen America's Healthcare, Dobson DaVanzo & Associates
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How a Rural Health System Continues to Provide Essential Obstetric Services
Podcast episode describing how Kittitas Valley Healthcare in rural Washington State worked to continue to provide obstetric services at its Critical Access Hospital (CAH) amid the departure of its full-time obstetric providers. Discusses the involvement of the governing board and recruitment and retention efforts.
Date: 07/2024
Sponsoring organization: American Hospital Association
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Podcast episode describing how Kittitas Valley Healthcare in rural Washington State worked to continue to provide obstetric services at its Critical Access Hospital (CAH) amid the departure of its full-time obstetric providers. Discusses the involvement of the governing board and recruitment and retention efforts.
Date: 07/2024
Sponsoring organization: American Hospital Association
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The Evolution of Health System Planning and Implementation of Maternal Telehealth Services During the COVID-19 Pandemic
Analyzes the impact of telehealth to provide maternal healthcare services during the COVID-19 pandemic. Utilizes interview feedback from 15 health system leaders to discuss issues such as telehealth reimbursement, research, access, barriers, and integration. Includes commentary on telehealth use in rural areas.
Author(s): Monisa Aijaz, Burcu Bozkurt, Arrianna Marie Planey, et al.
Citation: Digital Health, 10
Date: 06/2024
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Analyzes the impact of telehealth to provide maternal healthcare services during the COVID-19 pandemic. Utilizes interview feedback from 15 health system leaders to discuss issues such as telehealth reimbursement, research, access, barriers, and integration. Includes commentary on telehealth use in rural areas.
Author(s): Monisa Aijaz, Burcu Bozkurt, Arrianna Marie Planey, et al.
Citation: Digital Health, 10
Date: 06/2024
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Rural Hospitals' Perspectives On Health System Affiliation
Brief exploring hospital affiliation with consideration for rural contexts. Discusses impacts on costs of services, quality of care, and system finances. Offers recommended steps when choosing to affiliate and metrics for evaluating success.
Author(s): Joel M. James, Keith J. Mueller, Dan M. Shane
Date: 04/2024
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Brief exploring hospital affiliation with consideration for rural contexts. Discusses impacts on costs of services, quality of care, and system finances. Offers recommended steps when choosing to affiliate and metrics for evaluating success.
Author(s): Joel M. James, Keith J. Mueller, Dan M. Shane
Date: 04/2024
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Rural Age-Friendly Health Systems, with Alan Morgan, Rani Snyder, and Jed Hansen
An episode of the Exploring Rural Health podcast featuring Alan Morgan, CEO of the National Rural Health Association, Rani Snyder, Vice President for Program at John A. Hartford Foundation, and Jed Hansen, Executive Director of the Nebraska Rural Health Association. Focuses on the Rural Age-Friendly Initiative, a John A. Hartford/NRHA partnership.
Date: 04/2024
Sponsoring organization: Rural Health Information Hub
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An episode of the Exploring Rural Health podcast featuring Alan Morgan, CEO of the National Rural Health Association, Rani Snyder, Vice President for Program at John A. Hartford Foundation, and Jed Hansen, Executive Director of the Nebraska Rural Health Association. Focuses on the Rural Age-Friendly Initiative, a John A. Hartford/NRHA partnership.
Date: 04/2024
Sponsoring organization: Rural Health Information Hub
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Rural Health Leadership, with Steve Simonin
An episode of the Exploring Rural Health podcast featuring Steve Simonin, President and CEO of Iowa Specialty Hospital and Clinics. Focuses on how healthcare systems can invest in their communities, strategies for ensuring long-term rural health sustainability, and the importance of maintaining communication with state and federal support systems.
Date: 03/2024
Sponsoring organization: Rural Health Information Hub
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An episode of the Exploring Rural Health podcast featuring Steve Simonin, President and CEO of Iowa Specialty Hospital and Clinics. Focuses on how healthcare systems can invest in their communities, strategies for ensuring long-term rural health sustainability, and the importance of maintaining communication with state and federal support systems.
Date: 03/2024
Sponsoring organization: Rural Health Information Hub
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