When rural residents leave their community for care that is available in their community (hospital bypass), the local hospital's financial condition may be adversely impacted, ultimately impairing access to care in the community. This project will estimate the rural hospital bypass rate using all-payer claims data for a set of states and compare patients based on the inpatient treatments and procedures received relative to those routinely provided by rural facilities.

Analysis will estimate all-payer (all-insurance types) inpatient bypass rates for rural hospitals using 2018 data. Bypass will be defined by comparing inpatient residence and the hospital service area within which the patient resides. Regression models, to be specified based on hypotheses and findings derived from the current bypass literature, will identify factors associated with hospital-level bypass rates. Factors will include hospital characteristics, such as patient mix and characteristics of the hospital service area including rurality. Logistic regression modeling will examine the probability of bypass at the inpatient stay level. Following the reviewed literature, factors hypothesized to affect the inpatient's bypass decision will include the patient's health status, and hospital and community characteristics.