Financial performance of rural and urban nursing homes: A comparative analysis

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2025-07-22 DOI:10.1111/jrh.70053

Gregory N. Orewa PhD, MBA, MSc, Rohit Pradhan PhD, MPA, Akbar Ghiasi PhD, Shivani Gupta PhD, MBA, Robert Weech-Maldonado PhD, MBA

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引用次数: 0

Abstract

Purpose

The financial sustainability of nursing homes is increasingly critical as the aging US population continues to grow. Rural facilities often encounter more significant economic challenges than urban counterparts. This study investigates the disparities in financial performance between rural and urban nursing homes in the United States, emphasizing the influence of organizational and environmental factors. A comprehensive understanding of these differences is necessary for the implementation of effective policy and management interventions.

Methods

The study used a longitudinal dataset (2018–2022) comprising 66,056 nursing home-year observations. Data sources included Centers for Medicare and Medicaid Services (CMS) Cost Reports, Payroll-Based Journal, Care Compare, LTCFocus, and the Area Health Resource File. The dependent variable was the operating margin. The primary independent variable, geographic location, was classified using Rural–Urban Commuting Area (RUCA) codes. We conducted multivariable linear regression with facility-level random effects and two-way fixed effects (state and year) to assess rural–urban financial disparities while controlling for organizational and environmental factors and the impact of COVID-19.

Findings

Rural nursing homes had lower operating margins than urban facilities in unadjusted models. However, after adjusting for organizational factors such as size, occupancy, and payer mix, the rural–urban difference was no longer significant. Environmental factors, including population demographics and income levels, contributed to financial disparities. COVID-19 exacerbated financial challenges, disproportionately affecting rural facilities.

Conclusions

Financial disparities between rural and urban nursing homes are not solely due to geographical location, but also stem from structural challenges. These insights have significant policy implications suggesting that addressing reimbursement rates, operational efficiency, and resource allocation is crucial to ensure the financial sustainability and quality care for aging populations.

Abstract Image

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农村和城市养老院财务绩效的比较分析

随着美国老龄化人口的持续增长，养老院的财务可持续性变得越来越重要。农村设施往往比城市设施面临更大的经济挑战。本研究调查了美国农村和城市养老院财务绩效的差异，强调组织和环境因素的影响。全面了解这些差异对于执行有效的政策和管理干预措施是必要的。方法采用纵向数据集（2018-2022），包括66,056家疗养院的年度观察数据。数据来源包括医疗保险和医疗补助服务中心（CMS）成本报告、基于工资的期刊、护理比较、LTCFocus和地区卫生资源文件。因变量是营业利润率。主要自变量是地理位置，使用城乡通勤区（RUCA）代码进行分类。在控制组织和环境因素以及COVID-19影响的情况下，我们采用设施水平随机效应和双向固定效应（州和年份）的多变量线性回归来评估城乡财政差距。结果在未调整的模型下，农村养老院的营业利润率低于城市养老院。然而，在调整了组织因素（如规模、占用率和付款人组合）后，城乡差异不再显著。环境因素，包括人口、人口结构和收入水平，助长了财政差距。COVID-19加剧了财政挑战，对农村设施造成了不成比例的影响。结论城乡养老机构的财务差异不仅是地理位置的差异，也是结构性挑战的结果。这些见解具有重要的政策意义，表明解决报销率、运营效率和资源分配问题对于确保老年人口的财务可持续性和高质量护理至关重要。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.