The proposed project will provide a cross-sectional analysis of hospital- specific consumer and primary care physician perceptions, preferences and behaviors in a national sample of small rural communities served by single hospitals when those hospitals reflect one of four sets of circumstances: (Type 1) the hospital is open and, by usual measures of days of care and general financial performance, is apparently """"""""doing well;"""""""" (Type 2) the hospital is """"""""at risk"""""""" of financial insolvency, but has been kept open by a subsidy from local tax revenues, by joining a larger health care system, by creative management or marketing, or by some other means; (Type 3) the hospital is clearly operating at a negative profit margin and is at """"""""very high risk"""""""" of closing; or (Type 4) the hospital has been closed as an inpatient facility and converted to another type of health care (or non-health care) use. A nationally representative sample of the residential populations of twenty-five communities in each of these four types will be selected for inclusion in the study after stratification with respect to bed size of the focal hospital and the density of the local supply of physicians. Within each of these 100 communities, random digit dialing (RDD) techniques will be used to identify samples of 100 households (a total of 10,000) for each of which a telephone interview will be conducted with an adult household representative dealing with the following subjects: (a) access, utilization and experience in the use of both hospital and physician services; (b) satisfaction with services used and their accessibility, including attitudes about the avail-ability and use of advanced medical technologies, specialized hospital services, and alternative sources of care; (c) patterns of (and reasons for) use of particular hospitals and other health care services in the immediate health care market area; (d) attitudes about the implications of a change in the availability or perceived stability of the local hospital facility; and (e) attitudes about what might be expected with regard to major changes in the availability of local health care services. In addition, a telephone survey of up to 10 practicing primary care physicians in each of these 100 communities will explore similar issues from the physicians' perspectives. The study will identify specific reasons why (and types of services for which) rural community residents choose to bypass (and rural physicians choose to refer outside) their own community hospitals and medical care facilities and providers. Moreover, the specific and intended effect of policy options currently under review (or in the early stages of implementation) will be presented to respondents as preference options. Data from the study will permit the estimation of the extent to which residents of these communities are willing to accept these proposed arrangements for the provision of hospital services, which in some cases may involve significant reorganization or conversion of their hospital to another type of facility offering a different scope of care.
