U.S. Department of Health and Human Services data were analyzed to compare rural and urban hospitals on two metrics: 1) the percentage of hospitalized patients with COVID-19, and 2) the percentage of hospital beds occupied by patients that have COVID-19.

Rural hospitals have a higher percentage of hospitalized COVID-19 patients than urban hospitals. In most census divisions, the percentages of currently hospitalized patients with COVID-19 are higher in rural hospitals than in urban hospitals. Figure 1 shows the percent, among all patients in the hospital, with COVID-19. In the Midwest and South, rural hospitals are four to eight percentage points higher, indicating COVID-19 patients are relatively more common in rural hospitals in those regions.

Rural hospitals have more relative bed capacity than urban hospitals, but they may face great challenges with staffing. In all census divisions, rural hospitals have a higher percentage of available beds than urban hospitals. This suggests that some rural hospitals may prove an effective "safety valve" as urban hospitals reach capacity. Some state policies have increased payment for rural hospitals willing to treat urban overflow patients with COVID-19. Of course, many rural hospitals face challenges in staffing these open beds.

Policy Implications: Tighter capacity in urban hospitals could limit rural residents' ability to access advanced healthcare services (including ICU beds and ventilators) if urban hospitals limit or reject transfers. Rural hospitals may be able to accept low-acuity patients transferred from urban hospitals to expand capacity.