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

• Published in: Health services research 2022-10, Vol.57 (5), p.1029-1034
• Main Authors: Friedman, Hannah R., Holmes, George Mark
• Format: Article
• Language: English
• Subjects: Aged; Beneficiaries; Commuting; Company business management; Data collection; Economic aspects; geographic/spatial factors/small area variations; Government programs; health care organizations and systems; Health facilities construction; Health Services Accessibility; Hospitalization; Hospitals; Hospitals, Rural; Hospitals, Urban; Humans; Innovations; Management; Medicare; Polls & surveys; Postal codes; Research Brief; Rural areas; Rural communities; Rural health; Rural Health Services; Rural Population; Service areas; Surveys; United States; Urban areas; Urban health care
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.14017

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