Independent, Rural Healthcare Systems

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Independent, Rural Healthcare Systems

Three benefits that independent, rural healthcare systems provide to customers that are different from larger systems include the availability of additional services at independent rural hospitals; local control; and relative ease of fundraising to provide facility upgrades, services, and technologies. A deeper look at these benefits is below.


  • According to, one benefit that independent rural hospitals have over larger urban systems is that because they are often the "sole local source for patient care in rural communities, they are more likely to offer additional services that otherwise would not be accessible to residents."
  • For instance, statistics show that rural hospitals are more likely than urban hospitals to offer skilled nursing (21.2% rural compared to 16.6% urban), hospice (14.5% rural compared to 9.5% urban), and home health (31.2% rural compared to 19.2% urban) services likely because they would not otherwise be available from third-party providers in a rural setting.
  • Winona Health, an independent facility in Minnesota offers a "35-bed hospital, a nursing home, three clinics, and two assisted living communities", services that are typically not available at urban hospitals.
  • Waverly Health Center in Iowa offers a "birthing center, emergency department, physical therapy, cardiac rehabilitation services and specialty clinic among other services more unusual for smaller hospitals, including a spa and psychiatrist on staff."
  • According to Jim Atty, CEO of Waverly Health Center, the added services have increased patient satisfaction and that the center was one of only about 12 hospitals in Iowa to earn a "full five-star rating from the Centers for Medicare and Medicaid Services, which rated 3,500 of the country's hospitals on patient experience."
  • The presence of additional services at an independent, rural hospital directly influences patient experience, as they are able to take advantage of these services that they would not normally have access to.


  • According to HealthLeaders, independent hospitals are in control of their own destiny because "just as all healthcare is local, so leadership of the healthcare organization should also be local."
  • This local control means the community maintains control of one of its "greatest assets" and allows for the hospital to "deliver what's best for the community based on community members themselves."
  • For example, Winona Health has turned its entity into a "holistic organization focused on the healthcare needs in its community." A large urban hospital would not be able to be as responsive to community needs.
  • Rachelle Schultz, president and CEO of Winona Health, says that because the leadership is made up of members of the community, many of their "conversations are around knowing what [their] community needs and not handing that over to allow someone else to make those decisions."
  • Barry Goettsch, CEO of Marengo Memorial Hospital in Iowa stated the main benefit of being independent is "not being owned or managed by the system." He said, "We are truly a local health care provider. The autonomy we have as an independent facility means we can make the best decisions for us."
  • Local control directly benefits patients of rural healthcare systems because it is easier to assess and respond to community needs if there is no affiliated healthcare network from which permission or approval is required.


  • Fundraising for physical improvements to a local hospital or facility can be easier for independent healthcare systems because its importance to the rural area.
  • As Sheila Tjaden, primary fundraiser for Jones Regional Medical Center in Iowa stated, "small-town residents are willing to open their pockets and give because they rely on the hospital's services and understand how much of an asset it is to the community."
  • Jones Regional Medical Center CEO Eric Briesemeister agreed, stating, "They know us intimately and know we offer high-quality services... People support things they know."
  • Likewise, local businesses and the municipality itself are usually willing to chip in to support capital improvements to local healthcare facilities.
  • Easier fundraising allows rural healthcare systems to build facilities, offer services, and implement technologies that are necessary to "better treat an aging population with multiple chronic conditions," which is the predominant demographic using rural healthcare facilities. As such, the ability to fundraise directly benefits customers of rural healthcare systems.


  • Based on the NEJM Catalyst Insights Council Survey on Care Redesign, primary care is a strength of rural healthcare systems, with 60% of respondents rating primary care quality "very good" or "excellent" in rural settings.
  • Respondents rated patient experience as the best aspect of rural care, with 37% of respondents rating rural patient experience "better" or "much better" than the patient experience at urban healthcare facilities.
  • In addition, 32% of respondents rated the cost of care at rural healthcare facilities "better" or "much better" than the cost of care at urban facilities.
  • Healthcare professionals cited "quality of life, less bureaucracy and more autonomy in decision-making about patient care, access to specialists via telehealth, and lower cost of living" as reasons they would consider practicing medicine in a rural setting.


In attempting to identify benefits that independent, rural healthcare systems provide to customers that are different from larger systems, we began by searching through industry publications from,, Health Leaders, and others. We found some very nebulous benefits that included rural hospitals offering more services than urban hospitals and local control, but the details for these benefits were thin. Most of what was covered in these publications are challenges of independent, rural healthcare systems and possible solutions.

As such, we switched strategies and began looking for surveys from patients about what they are satisfied with concerning rural healthcare systems. We did not locate such a survey despite searching through consulting company websites like Deloitte and McKinsey and through government sites like the Center for Disease Control, the Centers for Medicare and Medicaid Services, and the Agency for Healthcare Research and Quality, among others. We did locate a survey conducted among healthcare professionals about what they believe rural healthcare systems do well, the results of which we included as other insights.

Finally, we searched for case studies of rural hospitals and healthcare systems to determine what their strengths were that could be translated into advantages for patients. We identified several examples of high-performing rural healthcare facilities and were able to find more details about the additional services offered by independent, rural hospitals. We added these findings to those benefits and explained how those benefits directly impact the care provided to rural patients (customers). In addition, we found one other benefit that rural healthcare facilities have over larger, urban facilities, which is that it can be easier to fundraise for facility, service, and technology improvements. We assumed that the access to these funds would directly improve patient experience, so we included it as a benefit.

Overall, there is very little information on how rural healthcare systems positively compare to larger systems. In most cases, independent rural healthcare systems are either struggling to stay operational or are struggling to stay independent. Much of the information we found deals with benefits to rural systems partnering with networks or larger entities to remain solvent. Other analyses are focused on the challenges that rural healthcare systems face, including lack of funding, uninsured patients, an aging population, access to care, access to technology, and physician shortages. In light of this, we were only able to identify three benefits that independent, rural healthcare systems provide to customers that are different from larger systems.