Dr. Joanna Jiang

Financially Distressed Hospitals Found to Benefit from System Affiliation

MedicalResearch.com Interview with:
Dr. Joanna JiangJoanna Jiang, PhD
Agency for Healthcare Research and Quality
Rockville, Maryland

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: Over the last decade we have seen two trends occurring to rural hospitals – closures and mergers. A hospital in financial distress could likely face closure. But if the hospital affiliates with a multihospital system, it may have access to resources from the system that help shelter the hospital from closure.

That is exactly what we found in this study. System affiliation was associated with a lower risk of closure for financially distressed hospitals. However, among hospitals that were financially stable, system affiliation was associated with a higher risk of closure. This is somewhat puzzling and needs further study to better understand the reason for closure.

MedicalResearch.com: What should readers take away from your report?

Response: The main takeaway from this study is that system affiliation appears to mitigate the risk of closure only among financially distressed hospitals.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should identify what non-financial factors may contribute to the risk of closure among hospitals doing well financially, and especially what happens after a hospital merges with another hospital or system that may inadvertently increase its risk of closure. For example, does the type of the affiliated system also matter?


Jiang HJ, Fingar KR, Liang L, Henke RM. Risk of Closure Among Independent and Multihospital-Affiliated Rural Hospitals. JAMA Health Forum. 2022;3(7):e221835. doi:10.1001/jamahealthforum.2022.1835 

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Last Updated on July 12, 2022 by Marie Benz MD FAAD