Local and Non-Local Hospital Use by Rural Iowans. Executive Summary

摘要

The research pursues what patient and hospital attributes affect a ruralresident's decision to bypass the closest hospital. The study focuses on 100,000+ rural Iowans hospitalized in Iowa in 1988 whose nearest hospital was the type most vulnerable to failure. Bypassing among medical, surgical, and obstetric sub-groups is also examined. Discharge data provide the primary data source. Bypassing is widespread even among patients whose conditions could have been treated locally. Attributes most predictive of the probability of bypassing include: (1) distance to the nearest hospital, (2) lack of accreditation in the nearest hospital, and (3) residence in a county adjacent to an urban county. Policy recommendations differ according to a rural hospital's risk of being bypassed. Communities with high risk hospitals should be helped to downgrade to essential services and improve patient access to other needed services available in more distant locations. Low risk hospitals should be assisted to remain attractive to rural clientele.