System affiliation may lead to an increase or decline in the number of services offered in a local hospital. This may have positive or negative effects for patients and may change both access to care and quality of care. This policy brief aims to understand the range of effects on service offerings after rural hospitals become part of, or leave, a regional or national healthcare system.

Key Findings:

• Of the 62 service offerings examined in the study period (2008 through 2020), researchers found more substantive (with a change of 5-percentage points or more) service line increases than decreases in rural hospitals, with 23 services having substantive increases and 10 services having substantive decreases.
• Changes in service offerings (either gains or losses) occurred across all hospital types regardless of whether the hospitals joined or left systems or were never or always in a system.
• Compared with hospitals that were never or always in a healthcare system, gains in healthcare services occurred more frequently in hospitals that left systems (35.4 percent), while the majority of service losses occurred in hospitals that joined systems (46.2 percent).