Date of Award

Spring 3-14-2025

Embargo Period

1-1-2026

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration and Policy

College

College of Health Professions

First Advisor

Dunc Williams

Second Advisor

Kevin Wiley

Third Advisor

Tim Putnam

Abstract

This study examined the organizational, operational, and financial characteristics of rural critical access, rural non-critical access, and urban hospitals. The objective was to assess hospital capital spending, an important indicator of financial reinvestment within an organization.

In 2022, critical access hospitals allocated 6.2% of total expenses to capital spending, compared to 5.8% for rural non-critical access and 6.5% for urban. In 2011, these figures were 8.4%, 7.2%, and 7.2%, respectively. Regression-adjusted results revealed that from 2011 to 2022, each additional year contributed to a 2.6% decrease in capital expenses relative to total expenses across all hospitals. Critical access hospitals spent 13.7% more on capital relative to total spending than rural non-critical access and 12.3% more than urban.

Capital spending is a long-term bellwether for financial health. However, recent decreases in capital expenses relative to total expenses indicate that hospitals have been proportionally reinvesting less over time. These decreases are significant for rural non-critical and critical access hospitals to monitor since many rural operate under slim margins, face a higher risk of closure, and have not kept pace with urban hospitals' capital reinvestments.

Rights

Copyright is held by the author. All rights reserved.

Available for download on Thursday, January 01, 2026

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