Factors Influencing Rural Residents' Utilization of Urban Hospitals

Abstract

Objective-To examine, using nationally representative data, which patient, hospital, and county characteristics influence rural residents' urban hospitalization.Methods-Rural residents hospitalized in urban hospitals (crossovers) are compared with those hospitalized in rural hospitals (noncrossovers). National Hospital Discharge Survey data were merged with Area Resource File and Centers for Medicare & Medicaid Services data to study rural inpatients' characteristics; hospital descriptors; and county or state socioeconomic and health service variables. Multivariate logistic regression analysis identified covariates of the likelihood of being a crossover.Findings-About one-third of the rural resident hospitalizations in 2003 were in urban hospitals. Other factors constant, those requiring greater resources had higher odds of crossing over, as did younger inpatients, those transferred from other hospitals, receiving surgery, and with mental diagnoses or congenital anomalies. Males, emergency admissions, and intervertebral disk disorder inpatients had lower odds of crossing over compared with those who were not in these categories. Crossover patients' hospitals had higher Medicare case mix indices than hospitals used by noncrossovers. Rural inpatients in government hospitals, rather than proprietary or non-profit hospitals, had greater odds of crossing over, as did rural patients from counties with lower population density, fewer hospital beds, more hospitals, more commuters, and lower per capita income compared with those in other categories.Conclusions-Rural hospitals continue to be an important source of inpatient care, but rural residents travel to urban hospitals in some specific instances.

30-Day Risk-Standardized Mortality and Readmission Rates After Ischemic Stroke in Critical Access Hospitals

“…31 Several studies report that rural patients who are younger are more likely to be transferred to urban hospitals than older patients. 32-38 Patients may also prefer to be treated at local CAHs and refuse transfer to distant larger, better-equipped and staffed medical centers. 29, 30 …”

An Overview of Distribution of Births in United States Hospitals in 2008 with Implications for Small Volume Perinatal Units in Rural Hospitals

“…In 1985, 24% of rural counties lacked OB services; by 2002 this number had risen to 44% (Zhao). Many women in rural areas therefore live far from hospitals offering OB services (ACOG, 2009; Hall et al, 2010). It is estimated that 5.8 million U.S. women live in rural counties without an obstetrician (NCHS, 2007), and nearly 80% of women in the most rural counties do not have access to a local hospital with OB services (ACOG).…”

“…In 1985, 24% of rural counties lacked OB services; by 2002 this number had risen to 44% (Zhao). Many women in rural areas therefore live far from hospitals o¡ering OB services (ACOG, 2009;Hall et al, 2010). It is estimated that 5.8 million U.S. women live in rural…”

Rural-Urban Differences in Health Care Expenditures: Empirical Data from US Households

“…Nevertheless, the MEPS did not identify location of providers or the distances between users' homes and providers. Likewise, detailed information about physicians' referral patterns, hospital characteristics, and county characteristics were found to influence choice of healthcare providers [29,30]. But the MEPS data set provides no information to assess the associations of these factors with health care expenditures.…”