Association between Mergers and the Provision of Pediatric Services in Rural Hospitals from 2011 to 2021

Abstract

Objective: To evaluate the association between hospital mergers and provision of pediatric inpatient services in rural hospitals from 2011-2021. Methods: Using data from the American Hospital Association Annual Survey and Centers for Medicare & Medicaid Services Provider of Service files, we conducted a retrospective cohort study of U.S. rural hospitals. The primary outcome was provision of pediatric inpatient services. We used logistic regression with robust standard errors to examine the association between hospital mergers and pediatric service provision, adjusting for hospital characteristics and geographic factors. Results: Among 2,205 rural hospitals, 100 (4.5%) underwent a merger during the study period. Merged hospitals were larger (mean 107.5 vs 58.3 beds) and less likely to be critical access hospitals (14.0% vs 56.9%) than independent hospitals. After adjusting for hospital and geographic characteristics, merged hospitals had 30% lower odds of providing pediatric services compared to independent hospitals (OR=0.70, 95% CI: 0.51-0.97). Each year was associated with 2% lower odds of pediatric service provision (OR=0.98, 95% CI: 0.97-0.99), with similar declines in both merged and independent hospitals. Regional variation was substantial, with hospitals in the South showing particularly lower odds of pediatric service provision (OR=0.40, 95% CI: 0.36-0.43) compared to the Midwest. Conclusion: Rural hospital mergers are significantly associated with reduced probability of providing pediatric inpatient services. As hospital consolidation continues, policies that balance financial sustainability with preservation of essential pediatric services are needed to prevent exacerbation of rural health disparities for children.