This new brief, The Impact of High Hospital Fixed-Cost Ratios on Rural Populations, describes the regional variation in Critical Access Hospital (CAH) and Low-Volume Hospital (LVH) status with respect to average fixed-to-total-cost ratios, finding that CAHs tend to have the highest ratios, followed by LVHs. However, the average ratio for each status differs regionally across the United States.

Key Findings:

• Fixed-to-total-cost ratios vary along the rural continuum. Recent RUPRI research found that hospitals in noncore counties without towns of at least 2,500 people have the highest ratios, with a median estimate of 0.933 (where 1 means 100 percent of costs are fixed). Moreover, groups of distinct fixed-to-total-cost profiles emerged based on Urban Influence Codes (UICs).
• As UIC groups become more rural, hospitals’ estimated fixed-to-total-cost ratios increase. Populations in those UIC groups tend to be older, more likely to be on Medicare or Medicaid, less likely to have a college education, and less likely to have employer-sponsored insurance.
• CAHs and LVHs have higher fixed-to-total-cost ratios. CAHs are concentrated in the upper Great Plains states, with 80.5 percent and 77.6 percent of all nonmetropolitan hospitals in North Dakota and Montana, respectively, having the CAH designation. LVHs tend to be in the South—46.6 percent of Alabama’s nonmetropolitan hospitals have the LVH designation—and are also common in some Mountain states.
• Because the level of rurality itself matters, policymakers could identify ways that this insight could be used to refine payment policies to better support all Americans’ access to hospital services.

Authors:  Abigail Barker, PhD; Eliot Jost, MBA, MPH; Timothy McBride, PhD; and Keith Mueller, PhD

Protecting pregnant women and infants from the health risks of a warming climate

Extreme heat, defined as a period of time when temperatures stay above 90 degrees Fahrenheit for several days, now contributes to nearly half a million deaths each year. One at-risk group is pregnant women because pregnancy increases the risk of heat-related illness. This is due to the body working harder to cool both the mother and baby, making it easier to overheat and harder to stay hydrated, factors that may contribute to pregnancy complications. Another at-risk group is infants whose bodies are not yet equipped to regulate heat. On the latest episode of “Growing Impact,” a team of researchers discussed their project that looks to inform lawmakers with actionable insights to protect these at-risk groups.

Ruohao Zhang is an assistant professor of agricultural economics, sociology and education at Penn State and principal investigator on the project. He said California, which is known for its warm climate and abundant sunshine, experiences more frequent heat waves than many other parts of the U.S. According to a report from the California Department of Insurance, the state saw seven major extreme heat events between 2013 and 2022, resulting in nearly 460 deaths and an estimated $7.7 billion in economic losses.

“Climate change makes extreme weather events more frequent, including these extreme temperature events,” he said. “The vulnerability of individuals such as low-income minorities, seniors, children and pregnant women are usually more affected by the extreme weather events. In this project, we are investigating the health impact of extreme temperature events. We are also exploring the socio-economic disparities in relation to these extreme temperatures.”

For example, low-income households often don’t have or can’t afford to use air conditioning.

“Households can certainly use air conditioning systems to overcome extreme temperatures, but it comes with less affordable energy bills,” Zhang said. “This makes the impact of the extreme temperature disproportionately greater on low-income households. We hope our study will inform government policies related to affordable energy that may help address social inequity concerns regarding the resilience against these climate change and extreme weather events.”

Kristin Sznajder, a collaborator on the project, is an assistant professor of public health sciences in the Department of Public Health Sciences and the Penn State College of Medicine. She said because of socio-economic disparities, pregnant women from low-income communities may suffer more from extreme temperatures.

“Think about the potential long-term impact on newborns, despite the immediate social inequity concerns we have here. This may also worsen future social justice challenges by amplifying the intergenerational transmission of health inequity,” she said. “Maternal health in the U.S. is of real national importance. Our outcomes in this country are worse than in other developed countries.”

According to a 2024 report from The Commonwealth Fund, the U.S. has the highest rate of maternal deaths among wealthy countries, especially for Black women, and more than 80% of these deaths could be prevented.

“Growing Impact” is a podcast by the Institute of Energy and the Environment. It features Penn State researchers who have been awarded IEE seed grants and discusses their foundational work as they further their projects. The podcast is available on multiple platforms, including YouTube, Apple, Amazon and Spotify.

“Worker displacement” is the separation of long-tenured workers from their employer in a way that is involuntary, permanent and independent of on-the-job performance. This issue affects all Appalachians, regardless of age, education level or industry.

In our new research report, Worker Displacement in Appalachia, we examine how displacement rates vary throughout the region, based on a number of factors, and the outcomes workers face after job loss. 📅

Using data from the most recent Displaced Worker Supplements, along with other sources, the report sheds light on the experiences of displaced workers in Appalachia and provides insights to target resources to the group.

Worker Displacement in Appalachia is online now!

New data recently released show that Appalachia’s labor force participation continues to improve, although population growth is slower than in the nation as a whole.

This new data comes as part of our 15th annual update of The Appalachian Region: A Data Overview from the 2019-2023 American Community Survey, also known as “The Chartbook.”

The Chartbook offers a world of data on the Appalachian Region; dive in now!

More Key Takeaways From The Chartbook: 

⚙️ Decrease in Unemployment  
Appalachia’s unemployment rate decreased by 0.8 percentage points between 2014-2018 to 2019-2023, compared to a 0.4 percentage point decrease in the rest of the U.S.

🏠 Homeownership ️ 
Among occupied housing units, homeownership in the region was 6.7 percentage points higher than in the U.S. overall.

💵 Household Income  
At $64,588, the median household income in Appalachia is nearly $14,000 below the U.S. average of $78,538.

💸 Cost Burdens  
The share of households in Appalachia that are cost burdened — where housing costs are 30% or more of monthly income — is 6.7 percentage points lower than the U.S. average.

The Pennsylvania Health Care Cost Containment Council (PHC4) has released quarter four 2024 data.  This data includes facility charges and treatment information from Pennsylvania hospitals and ambulatory surgery centers. Inpatient and ambulatory/outpatient administrative and revenue Q4 2024 data files are available for purchase.

First quarter 2025 data is scheduled to be released October 2025.

For a fee, businesses, organizations, or individuals can request from PHC4’s Special Requests unit standard “ready-to-use” data or custom data that is generated based on specific populations. The data can also be linked to other data sources, such as the Pennsylvania vital statistics data from the Pennsylvania Department of Health, to provide even greater value to you. Our analysts will work with you to meet the needs of your health care study or project.

By fostering a data-driven approach to health care, PHC4 envisions a healthier, more resilient society where resources are allocated effectively, and lives are improved. PHC4 aims to continue to serve its mission of empowering Pennsylvanians through transparency and welcomes you to review its public reports at phc4.org.

PHC4 is an independent council formed under Pennsylvania statute (Act 89 of 1986, as amended by Act 15 of 2020) in order to address rapidly growing health care costs. PHC4 continues to produce comparative information about the most efficient and effective health care to individual consumers and group purchasers of health services. In addition, PHC4 produces information used to identify opportunities to contain costs and improve the quality of care delivered.

For more information, visit phc4.org or contact Special Requests and click here to request data.

Media contact:

Barry D. Buckingham, Executive Director, PHC4, bbuckingham@phc4.org

The Economic Research Service at the U.S. Department of Agriculture (USDA) breaks down the federal-state partnership that delivers meals to about 100,000 public and private not-for-profit schools.  The report examines supply and demand in the last decade, the flow of funding, and challenges during and after the pandemic.

Click here to read the report.

In 2024, 19 people died of injuries suffered in farm-related incidents in Pennsylvania, according to researchers in Penn State’s College of Agricultural Sciences.

The Penn State Agricultural Safety and Health Program in the Department of Agricultural and Biological Engineering — which also is affiliated with Penn State Extension — releases the “Pennsylvania Farm Fatal Injury Summary” annually. Researchers and extension educators use these data to identify hazards and risks associated with agricultural production and to inform the development of trainings and resources.

The 19 farm-related deaths in the state last year is lower than the 25-year average of 28 deaths per year. However, agricultural fatalities can fluctuate significantly from year to year, and reported incidents may represent just the tip of the iceberg, experts noted, as injuries — another concern — are not well tracked.

Read more.

Nearly one in every 10 infants in the United States is born preterm, or before 37 weeks of gestational age, according to the Centers for Disease Control and Prevention. Infants born with very low birthweights — under 3.3 pounds at birth — are disproportionately very preterm — 29-weeks gestation or earlier. These infants make up 1% of births, but account for more than half of infant deaths in the United States each year. The mortality rate for infants born very preterm, and length of hospital stay, may vary across health systems, according to a new study by researchers at Penn State.

Led by Jeannette Rogowski, professor of health policy and administration at Penn State, the team found that where a very preterm baby is born or receives care immediately after birth can increase or decrease the chance of survival by two percentage points. The findings, which the researchers said demonstrate potential for quality improvement among the nation’s neonatal intensive care units (NICUs) in health systems, were published in JAMA Network Open.

A previous study led by Rogowski found that approximately 84% of very preterm infants are born in a hospital that is part of a consolidated multi-hospital system — a system with two or more hospitals. Among pediatric patients, very preterm infants are the most vulnerable population. However, the variation in the quality of care for very preterm infants across health systems was unknown. This study was the first to address this question, according to Rogowski.

Read more.

The COVID-19 Public Health Emergency (PHE) drove the expanded use of telehealth, during which time healthcare providers deferred elective and preventive visits and many patients avoided necessary healthcare services to minimize their risk of exposure, resulting in a shift to telehealth to provide access to essential healthcare services.

To date, little information has been available on the organizational challenges associated with the provision of telehealth services by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). This project asked leaders in selected RHCs and FQHCs to identify challenges, trends, and resources needed in adapting telehealth services to their settings.

Finding of this study include implementation and operational challenges as well as opportunities.

Please click here to read the brief.

Rural Telehealth Research Center
Rural Telehealth Research Center, University of Iowa, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242
Email: rtrc-inquiry@uiowa.edu
www.ruraltelehealth.org