Urban hospitals could take severe rural Covid-19 patients by transferring less-acute patients to rural hospitals

Percent of hospitalized Covid-19 patients in rural
vs. urban hospitals in the U.S. (N.C. Rural Health
Research Program chart; click to enlarge)

A pair of new studies show that rural hospitals had slightly higher percentages of Covid-19 patients than urban hospitals in the last quarter of 2020, but that rural hospitals had a greater percentage of beds available than urban hospitals. The upshot: rural Covid-19 patients with severe cases may have a harder time being transferred to urban hospitals because of limited urban bed availability. But urban hospitals could free up some beds for very sick rural Covid-19 patients if rural hospitals accepted transfers of less-acute urban patients. The studies were conducted by the North Carolina Rural Health Research Program at the University of North Carolina at Chapel Hill. 

The percentage of Covid-19 hospital patients was 4 to 6 percentage points higher in rural areas than in urban hospitals in that time period, according to the first study, based on data from the Department of Health and Human Services. That raises concerns about rural hospitals' ability to continue operating efficiently. Rural and urban hospitals saw about the same percentage increase in Covid-19 patients over the last quarter of 2020, according to the second study (from 10% to 25% in rural hospitals and from 6% to 20% in urban hospitals).

The second report says the tighter bed restrictions in urban areas could limit rural residents’ ability to get advanced services if urban hospitals limit or reject transfer patients. Conversely, the greater percentage of open beds in rural hospitals could help urban hospitals expand capacity if rural hospitals accepted transfers of patients with less need for acute care. At least one state, Colorado, is already doing this.