Health System Integration and Cancer Center Access for Rural Hospitals

Abstract

Background Cancer centers provide superior care but are less accessible to rural populations. Health systems that integrate a cancer center may provide broader access to quality surgical care, but penetration to rural hospitals is unknown. Methods Cancer center data were linked to health system data to describe health systems based on whether they included at least one accredited cancer center. Health systems with and without cancer centers were compared based on rural hospital presence. Bivariate tests and multivariable logistic regression were used with results reported as P-values and odds ratios (OR) with 95% confidence intervals (CIs). Results Ninety percent of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems ( P = .03) with more trainees ( P = .03) more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%, P = .43; adjusted OR .69, 95% CI .28-1.70). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations ( P = .02) in non-metropolitan areas ( P = .03). Discussion Health systems with rural hospitals are no more likely to have a cancer center. Ongoing health system integration will not necessarily expand rural patients’ access to surgical care under existing health policy infrastructure and incentives.