Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Jillian B. Harvey

Third Advisor

Annie N. Simpson

Fourth Advisor

John Duncan Williams


The phenomenon of patients choosing distant, hospitals in lieu of local hospitals is known as bypass behavior. High rates of patient bypass of local hospitals mean a potential loss of revenue which could affect a hospitals financial health. My dissertation addresses the question of how patient bypass behavior impacts rural hospital financial health in three aims, using archival billing data. My dissertation expands on the existing literature in two ways 1) by evaluating the current measurement of bypass rate and 2) by evaluating the impact of bypass behavior on hospital financial indicators. The results for the patient-level and hospital-level determinates are consistent with the established literature. The exploratory analysis of the association between bypass behavior and hospital financial indicators is promising. Understanding rural patient bypass behavior and its effect on financial indicators is paramount if rural hospitals are to develop alternative responses to help them survive in the ever-evolving healthcare landscape.


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