Category: Rural Health Research Gateway

Rural Health Research: A Comparison of Independent and System-Affiliated Rural Hospitals

March 12, 2026

Rural Health Research: A Comparison of Independent and System-Affiliated Rural Hospitals

Rural hospitals play a critical role in ensuring that people living in small towns and remote areas can access essential health care. However, many rural hospitals face ongoing financial pressures, staffing shortages, and declining patient volumes, all of which increase the risk of service cuts or closure. This brief examines how independent, and system affiliated rural hospitals differ across organizational structure, financial performance, community context, and financial distress risk, using the most recent national data to inform policymakers, researchers, and rural health stakeholders.

Key findings:

In this study, system-affiliated hospitals are defined as those that are part of a chain organization (as reported in the Medicare Hospital Cost Report), and independent hospitals are those that are not part of a chain organization. Considering organizational characteristics, financial performance, and county characteristics, this study found that, compared to system-affiliated rural hospitals, independent rural hospitals:

  • Had fewer acute beds.
  • Had a higher proportion that were Critical Access Hospitals, did not receive a low volume adjustment, did not participate in the Medicare Shared Savings Program, were government owned, operated Rural Health Clinics, provided long-term care, used swing beds, and were located in areas with Rural-Urban Commuting Area Codes 7-10 (small towns and rural areas).
  • Were substantially less profitable, had lower net patient revenue and acute average daily census, and had higher long-term debt and Medicare inpatient payer mix.
  • Were in counties with a smaller population, a higher percentage of residents in rural areas, and higher uninsured rates.

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Rural Health Research: Examining the Burden of Chronic Disease and Low SES to Identify High-Need Rural Counties

February 19, 2026

Rural Health Research: Examining the Burden of Chronic Disease and Low SES to Identify High-Need Rural Counties

This study identifies rural counties with high chronic disease burden and low socioeconomic status; describes the geographic and demographic patterns of these high-need counties; and examines whether counties with greater need also experience reduced geographic access to critical health care services.

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Rural Health Research Alert: Use of Preventive Services by Rurality, Disability Status, and Health Insurance

February 2, 2026

Rural Health Research Alert: Use of Preventive Services by Rurality, Disability Status, and Health Insurance

High-quality health care, including use of preventive services, is important to maximize health and well-being. Both rural residents and people with disabilities experience specific barriers to quality care but less is know about use of preventive care at the intersection of disability status and geographic location. Even less is known about how those relationships vary by insurance status. This policy brief examines rates of utilizing two types of preventive care (routine physicals and flu vaccination) by rural-urban location, disability status, and health insurance type.

Key Findings:

  • People with disabilities and adults 65 and older were more likely than their counterparts without disabilities and those under age 65 to have had a routine physical and to have received a flu vaccination within the last year.
  • People who were uninsured had much lower probabilities of having a routine physical compared to their privately insured counterparts, regardless of rurality or disability status, ranging from over 48% – 58% without insurance compared to over 79% – 88% with private insurance.
  • People who were uninsured had the lowest probabilities of flu vaccination, especially compared to people who were privately insured, regardless of rurality and disability. The lowest probability of flu vaccination overall was among uninsured rural residents without disability (19%).

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Access to Health Care by Rurality and Disability Status

January 22, 2026

Access to Health Care by Rurality and Disability Status

People with disabilities face challenges with finding accessible transportation, barriers in access to quality care, as well as increased financial burdens. Although access to care is a population health concern, there is less research on how access varies at the intersection of rurality and disability status.

This policy brief from the University of Minnesota Rural Health Research Center examines various financial and non-financial barriers to health care access among rural and urban individuals by disability status.

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Rural Health Research: Rural-Urban Differences in Homebound Status by Health and Functional Limitations

January 14, 2026

Rural Health Research: Rural-Urban Differences in Homebound Status by Health and Functional Limitations

Without access to adequate institutional or home and community-based care, older adults may become homebound, a state that is associated with poorer health outcomes, higher rates of hospitalization and emergency department use, and greater risk of social isolation, functional decline, and mortality. Yet, little is known about how rates of being homebound differ between rural and urban older adults by specific health indicators. This brief from the University of Minnesota Rural Health Research Center addresses that gap.

Key Findings:

  • Rural and urban Medicare beneficiaries age 65 and older reported similar rates of being homebound (5.7% and 6.1%).
  • Rural older adults in very good health (on a scale from poor to excellent) were less likely than their urban counterparts to be homebound (0.4% vs. 2.1%). However, rural older adults in poor health were more likely to be homebound than urban older adults in poor health, although the difference was not statistically significant (35.7% vs 27.1%).
  • Among both rural and urban older adults, the highest rates of being homebound were among people with diagnoses of dementia (26.6% and 26.2%, respectively) and stroke (24.0% and 13.3%).

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Rural Health Research: Transportation for Rural People with Disabilities: Example Programs from Minnesota and Idaho

January 14, 2026

Rural Health Research: Transportation for Rural People with Disabilities: Example Programs from Minnesota and Idaho

Transportation is a well-documented social driver of health with particularly unique features and challenges in rural communities. Beyond being an important driver of health for rural residents generally, transportation at the intersection of rurality and disability is especially vital.

This case series from the University of Minnesota Rural Health Research Center examines how two rural organizations in Minnesota Rural Health Research Center examines how tow rural organizations in Minnesota and Idaho provide transportation services to individuals with disabilities in their areas.

Key Findings:

  • The United Community Action Partnership in Marshall, Minnesota provides accessible transportation through public transportation and volunteer driver services, as well as mobility management services to help individuals with disabilities coordinate transportation.
  • Mountain Rides in Ketchum, Idaho provides accessible transportation to rural residents through their Americans with Disabilities Act services as well as their Community Health Transit Program, which provides accessible transportation to medical appointments in neighboring cities for individuals with disabilities.

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Research Alert: Availability of Hospital-Based Obstetric Services in the United States by County, 2010-2023: A State-by-State Report

January 9, 2026

Research Alert: Availability of Hospital-Based Obstetric Services in the United States by County, 2010-2023: A State-by-State Report

Between 2010 and 2023, there have been continued declines in access to hospital-based obstetric services in both rural and urban U.S. communities. During this time, 269of the 3,144 counties (8.6%) in the U.S. lost all hospital based obstetric services; 26 of the counties that lost these services (21 of which were rural) experienced a recent loss, between 2022 and 2023. These losses have resulted in 60% of rural counties and 38% of urban counties not having any hospital-based obstetric services by 2023. Access to obstetric care is especially limited in less populated rural counties. Among rural noncore counties (counties without a town population >10,000), 148 counties (11%) lost all hospital based obstetric services between 2010 and 2023(15 of these losses occurred recently, between 2022 and 2023), resulting in only 24% of rural noncore counties having any hospital-based obstetric services by 2023.

Additionally, there is variation across states in county-level hospital based obstetric services availability. Between 2010 and 2023, there were nine states where more than ten counties lost all hospital-based obstetric services. In Iowa, 20 counties lost all hospital-based obstetric services during this time. In the most recent year of data available (between 2022 and 2023), obstetric service losses at the county level were concentrated in California, Idaho, Indiana, Minnesota, and Nebraska, which lost services in tow counties each. Illinois and Kansas lost services in three counties (all of which were rural), and Ohio experience recent losses in four counties (two of which were rural). Only one state (North Dakota) recently gained hospital-based obstetric services in 2023 in a county without those services in 2022. This gain was in a rural noncore county.

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Rural Health Research Alert: Rural-Urban Differences in Barriers to Care and Utilization of Preventive Care Among Traditional Medicare and Medicare Advantage Beneficiaries

December 11, 2025

Rural Health Research Alert: Rural-Urban Differences in Barriers to Care and Utilization of Preventive Care Among Traditional Medicare and Medicare Advantage Beneficiaries

This policy brief examined rural and urban differences in barriers to care and use of preventive care services among enrollees in traditional Medicare and Medicare Advantage. Medicare Current Beneficiary Survey data was used to examine barriers to care, such as flu shots and cholesterol tests, comparing rural and urban Medicare Advantage enrollees, rural and urban traditional Medicare enrollees, and rural traditional and Medicare Advantage enrollees.

Key Findings:

  • Rural Medicare Advantage enrollees faced more barriers in accessing health services due to cost, compared to their urban counterparts and to all traditional Medicare enrollees, urban and rural.
  • A lower proportion of rural enrollees in both traditional Medicare and Medicare Advantage received a flu shot compared to their urban counterparts.
  • Female traditional Medicare enrollees living in rural areas were the least likely to utilize health care services compared to both their urban counterparts and Medicare Advantage enrollees.

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