Financial resilience of rural hospitals: Prepandemic vulnerabilities and Provider Relief Funds’ role during COVID-19

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2025-07-23 DOI:10.1111/jrh.70060

Saleema A. Karim MHA, MBA, PhD, Nathan W. Carroll PhD, Paula H. Song PhD, Adam Atherly PhD

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引用次数: 0

Abstract

Purpose

Rural hospitals struggling with prepandemic financial instability faced heightened challenges during COVID-19. While Provider Relief Funds (PRFs) offered essential support, their impact varied, highlighting the need to examine how prepandemic financial health influenced rural hospitals’ financial performance during the pandemic. This study evaluates PRF's role across three hospital categories: financially strained (low operating margin), financially vulnerable (midrange operating margin), and financially strong (high operating margin).

Methods

A cohort study with a pre–post research design analyzed 2243 US rural hospitals from 2017 to 2022. The sample included short-term general acute nonfederal hospitals and Critical Access Hospitals in nonmetropolitan counties and rural tracts within metropolitan counties. Financial health was assessed using operating margin measures and total margins with and without PRF across four time periods: pre-COVID-19 (2017–2019), COVID-19 Year 1 (2020), Year 2 (2021), and Year 3 (2022).

Findings

Financially strained and vulnerable hospitals represented 85% of rural hospitals. Financially strained hospitals had the lowest average operating margins from patient services (−17.36%), trailing financially vulnerable (−3.09%), and financially strong (8.04%). In COVID-19 Year 1, operating margins declined across all categories. PRF increased total margins for financially strained hospitals to 8.39% in 2021 before dropping to 0.76% in 2022. Financially vulnerable hospitals also benefited, while financially strong hospitals remained profitable even without PRF.

Conclusion

PRF played a critical role in stabilizing rural hospitals, mitigating financial declines, and preventing closures. Its expiration leaves many hospitals facing renewed financial pressures. Addressing long-term financial challenges through sustainable funding strategies and operational adaptations will be essential to preserving health care access in rural communities.

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农村医院的财务韧性：大流行前的脆弱性和提供者救济基金在COVID-19期间的作用

面临大流行前金融不稳定的农村医院在2019冠状病毒病期间面临更大挑战。虽然提供者救济基金提供了必要的支持，但其影响各不相同，突出表明有必要审查大流行前的财务健康如何影响农村医院在大流行期间的财务业绩。本研究评估了PRF在三种医院类别中的作用：财务紧张（低营业利润率）、财务脆弱（中等营业利润率）和财务强大（高营业利润率）。方法采用前后研究设计的队列研究，对2017 - 2022年美国2243家乡村医院进行分析。样本包括非大都市县和大都市县内农村地区的短期普通急性非联邦医院和危重医院。使用营业利润率指标和有或没有PRF的总利润率评估了四个时间段的财务健康状况：COVID-19前（2017-2019）、COVID-19第一年（2020）、第二年（2021）和第三年（2022）。调查结果：85%的农村医院处于财政紧张和脆弱状态。财务紧张的医院从病人服务中获得的平均营业利润率最低（- 17.36%），落后于财务脆弱的医院（- 3.09%）和财务强大的医院（8.04%）。在2019冠状病毒病第一年，所有品类的营业利润率均出现下降。PRF将财政紧张的医院的总利润率提高到2021年的8.39%，然后在2022年降至0.76%。财政脆弱的医院也从中受益，而资金雄厚的医院即使没有PRF也能盈利。结论PRF在稳定农村医院、缓解资金下降、防止关闭方面发挥了关键作用。它的到期使许多医院面临新的财政压力。通过可持续筹资战略和业务调整应对长期财政挑战，对于保持农村社区获得保健服务至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.