Rural hospitals that are acquired by larger hospitals or health systems are more likely to close their surgical services, and possibly their maternal- and neonatal-care services, too, than are rural hospitals that remain independent, according to researchers in the United States.

“Adults residing in rural areas are more likely to live in poverty, have health conditions, and have greater unmet health needs than adults in urban areas,” they write in Health Affairs. “Although a merger could salvage a hospital’s sustainability, it also could reduce service lines and responsiveness to community needs.”

Rural hospitals are increasingly in financial distress and may merge with other hospitals or health systems to boost their finances, Dr. Joanna Jiang of the Agency for Healthcare Research and Quality (AHRQ), in Rockville, Maryland, and colleagues say.

To better understand the consequences of such mergers, the researchers analyzed data from 172 rural hospitals in the U.S. that merged with larger health systems between 2009 and 2016. These hospitals were matched to 549 hospitals that did not merge during this period.

Rural hospitals that merged during the study period had more beds, were less likely to be critical-access hospitals, were more often in the South, and were typically more likely to be privately owned.

One year following the merger, there was a 6.7 percentage-point reduction in the proportion of hospitals that provided maternal/neonatal services compared with matched independent hospitals (P=0.06). Additionally, there was a 5.0 percentage-point decrease in the provision of surgical services among hospitals that merged compared with those that didn’t (P=0.027).

In an analysis of catchment area use, the researchers observed a significant 10.8 percentage-point higher rise in mental health or substance-use disorder stays at independent centers after one year, suggesting that communities with hospitals that were acquired may have had reduced behavioral-health care access following acquisition.

“However, among those hospitals that merged and kept these services, our study found no significant difference in changes in service volume between these hospitals and comparison hospitals that remained independent, suggesting that there was no negative impact on meeting the community needs,” Dr. Jiang told Reuters Health by email.

She noted that the closure of rural hospitals’ maternal/neonatal and surgical units may mean that patients who require these services have to drive farther to receive care, which poses a challenge to individuals with trouble accessing reliable transportation.

Dr. Jiang explained that hospitals require an assessment of the risk-benefit ratio of closing certain key services, particularly as it relates to the hospitals’ key demographics and community needs. “A full spectrum of potential benefits and harms of acquisitions, including the influence of acquisitions on patient experiences, quality, and cost, should be considered to assess whether benefits outweigh the risk,” she said.