Rural hospitals: A literature synthesis and health services research agenda

Several legislative attempts have been made to improve the operating environment of rural hospitals. In 1986, the 99th Congress passed the Rural Health Care Improvement Act, which directly helped rural hospitals in the areas of capital payments, retention of periodic interim payments (PIP), sole community provider payments, and outlier payments. The 100th Congress passed legislation that reduced the urban-rural differential in Medicare hospital payments. The Department of Health and Human Services has also created the Office of Rural Health to monitor rural health issues and coordinate public and private sector-rural health care initiatives. Clearly, the viability of rural hospitals has reemerged as an important policy issue. This article first presents an overview of recent trends affecting rural hospitals, then synthesizes the literature on rural hospitals, and finally proposes a health services research agenda for rural hospitals.