Many rural hospitals are responding to external threats by converting to provide services other than acute inpatient care. Such conversions allow rural communities to maintain access to certain health care services (e.g., primary care, emergency care), while representing a potential alternative to closure for some rural hospitals. Hospital conversion differs from other management strategies because it entails a major change in a hospital's mission and functioning. For this reason, conversion is likely to be a difficult and risky change. We now know very little about the number and type of rural hospital conversions or about the processes involved in conversion. The proposed study has three objectives. First, the proposed study will determine the number of various types of rural hospital conversions over a nine year (1983-1991) period using AHA and HCFA data for all rural hospitals in the nation. Second, the study will specify the processes involved in rural hospital conversion by examining changes in hospital capacity (e.g., number of beds), financial performance, and organizational arrangements (e.g., system affiliation). Using event history analysis, conversion processes will be modeled for three major conversion categories. Comparisons will be made across such categories to determine whether or not differences exist in how conversion occurs. Similar comparisons will be to non-converted rural hospitals and closed hospitals. Finally, the study will explore the role of state legislation in conversion by examining the number of conversions in states that do and do not have enabling policies. These analyses will result in a typology of rural hospital conversions that is empirically-based and that takes into account differences in the endpoints of conversion (e.g., conversion between levels of care vs. within levels of care) as well as differences in the process of conversion (e.g., abrupt vs. incremental change in hospital mission). Such a typology will allow researchers and policy-makers to distinguish among various forms of rural hospital conversion and will provide a basis for future studies to assess the consequences of conversion.
