Rural hospitals that joined chains were more likely to stop maternal and neonatal services, limit mental-health access

Average number of hospital stays for maternal/neonatal care, surgical services and mental health/substance-use disorder, for merged and independent hospitals (Health Affairs graph; click on the image to enlarge it)

Rural hospitals that were acquired in mergers from 2009 to 2016 were more likely than their independent peers to shutter their maternal, neonatal and surgical services, and more likely to limit access to mental-health care, on-site diagnostic technologies, and non-emergency outpatient services, according to a newly published study in the journal Health Affairs.

In essence, the researchers found, a merger might save a hospital from closing, but make it less responsive to community needs. Merged hospitals were also less likely to be critical-access hospitals, and more likely to be privately owned, have more beds than average, and be located in the South.

The study compared 172 rural hospitals that merged with larger systems between 2009 and 2016 and compared them with 549 hospitals that remained independent, using data from annual American Hospital Association surveys. In the year after hospitals were acquired, the average number that provided any maternal or neonatal services fell 6.7 percentage points more than independent hospitals. Two years afterward, that gap increased to 7.2 percentage points, but at three years post-merger and beyond, the gap virtually vanished.

One year after being acquired, merged hospitals were 5 percent less likely like to offer surgical services than independent hospitals. The statistical gap became insignificant two and three years after merger. Analysis showed that locals weren't accessing those services elsewhere nearby, so the data suggests that the merger didn't generally hurt patient access to inpatient care.

Admissions for patients with mental-health issues or substance-use disorders stayed about the same for the first two years after hospitals were acquired, but increased during the same time period for independent hospitals. That and other data suggests that communities with merged hospitals may have reduced access to behavioral health care.

The study is the second from the federal Agency for Healthcare Research and Quality and IBM Watson Health to examine the benefits and consequences to health-care access for people whose local hospital was acquired. The first one found that merged rural hospitals had lower overall lower death rates, especially from heart attacks.