Chronic Care, Health Care Systems and Services Integration

ISBN: 978-0-76231-147-7, eISBN: 978-1-84950-300-6

ISSN: 0275-4959

Publication date: 30 December 2004


This paper focuses on the impact of recent federal health policy on local community efforts to support the survival of rural hospitals. Rural communities in the United States have an established tradition of providing public financial support to local hospitals. The Balanced Budget Act of 1997 (BBA) expanded Medicare’s prospective payment system to non-acute care services, which promised reduced hospital reimbursement. Part of this legislation, the Critical Access Hospital (CAH) program, was specifically designed to counter the negative impact the broader legislation was expected to have. This study was designed to investigate the hypothesis that counties receiving financial relief for local hospitals through participation in the CAH program would show decreases in county subsidy levels compared to other hospitals. All 123 hospitals in Kansas were studied in 1994, well before BBA legislation, and again in 2001. Data on county-level health care spending for each of the two years were abstracted from all county budgets in Kansas. The amounts counties contributed to local hospitals were calculated and compared in terms of CAH versus non-CAH hospitals with attention to patterns of increase. Results showed that CAH hospitals, in spite of participation in the federal program, received greater local public financial support and experienced greater funding increases than other community hospitals. The implications of these findings are discussed in terms of the circumstances of rural hospitals and recent changes in the CAH program.


Zimmerman, M. and McAdams, R. (2004), "PUBLIC SUPPORT FOR RURAL HEALTH CARE: FEDERAL PROGRAMS AND LOCAL HOSPITAL SUBSIDIES", Jacobs Kronenfeld, J. (Ed.) Chronic Care, Health Care Systems and Services Integration (Research in the Sociology of Health Care, Vol. 22), Emerald Group Publishing Limited, Bingley, pp. 25-45.

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