All ETDs from UAB

Advisory Committee Chair

Nancy M Borkowski

Advisory Committee Members

James D Byrd

W Jack Duncan

Larry R Hearld

Jerry M Trimm

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


RURAL HOSPITAL CLOSURES IN ALABAMA: POST ACA DENNIS O. MCCAY HEALTH SERVICES ADMINISTRATION ABSTRACT Rural hospitals differ from their urban counterparts with regard to two main areas. First, rural hospital patients are usually older, of lower income, and less healthy than those in urban areas. Second, their facilities tend to be smaller, older, and more prone to staff shortages than those in an urban environment. Rural hospitals have been closing at higher rates than their urban counterparts for a number of years, but more so since the implementation of the Affordable Care Act in 2010. The objective of this research was to investigate the rural hospitals in the state of Alabama in an attempt to understand if they are in financial distress and, if so, what environmental factors might be associated with their distress. This dissertation is comprised of three studies. The first study is a literature review of the existing work pertaining to the use of population ecology (PE) theory in the study of the hospital industry since 1983. The intent of this study was to understand the parameters of previous research that examined environmental factors associated with hospital wellbeing from an environmental point of view. The second study is a statistical logistic regression analysis that investigates all of the existing rural, acute-care hospitals in Alabama regarding their financial wellbeing (represented by their Altman-Z”-Score) and other selected micro and meso environmental factors. The purpose of this study is to identify which, if any, of the rural hospitals are in financial distress, and if so, to identify if any of the selected environmental variables are associated with their distress. Study three is a case study of the Alabama acute-care hospitals that have either closed or ceased their inpatient operations since 2010. It evaluates a selected group of micro and meso environmental factors for similarities or differences in their organizations or communities to understand why they closed when other similar hospitals continued to operate.



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