WEDNESDAY, Dec. 4, 2019 (HealthDay News) — While affiliating with health systems may boost a rural hospital’s financial viability, the affiliation is often associated with reductions in critical services, according to a study published in the December issue of Health Affairs, a theme issue on rural health.

Claire E. O’Hanlon, Ph.D., from the Veterans Affairs Greater Los Angeles Healthcare System, and colleagues examined the relationship between health system affiliation and performance among rural hospitals (2008 to 2017). Rural hospitals that affiliated with a health system were compared to a propensity score-weighted set of nonaffiliating rural hospitals for 12 measures of structure, utilization, financial performance, and quality.

The researchers found that following health system affiliation, rural hospitals experienced a significant reduction in on-site diagnostic imaging technologies, the availability of obstetric and primary care services, and outpatient nonemergency visits. The investigators also observed a significant increase in operating margins (by 1.6 to 3.6 percentage points from a baseline of −1.6 percent). The affiliating and nonaffiliating hospitals were similar with respect to patient experience scores, readmissions, and emergency department visits.

“While joining health systems may improve rural hospitals’ financial performance, affiliation may reduce access to services for patients in rural areas,” the authors write.

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