Efficacy of System Management or Ownership as Options for Distressed Small Rural Hospitals

Systems linkages through signing a management contract or selling to a multihospital system have been advocated as strategies for addressing the distress of small rural hospitals through increased management capacity. This national study compares 311 independent self‐managed hospitals, 194 independent systems‐managed and 235 systems‐owned and managed hospitals in relation to occupancy levels and secondary measures of performance. Almost no differences were found in performance among the three groups. Distress was found to be highly associated with hospitals under 50 beds and less supportive environments. The data presented suggests that many of the advantages of systems linkage may be obtained in other ways and that a management contract or sale to a multi‐hospital system may not solve the problems of a rural hospital.