National rural hospital baseline
Where are the country's rural hospitals, and how much of each state's hospital capacity is rural? Joining every hospital CMS lists to the USDA county rural classification: 1847 of 5,366 hospitals (34.4%) sit in nonmetro counties, which hold 13.8% of US residents. Rural facilities are roughly 2.5 times as numerous as population alone would imply, because distance rather than density decides where a hospital has to be. 1,338 carry the Critical Access designation, led by Texas (93), Iowa (82), Kansas (82). 239 hospitals could not be matched to a county code and are reported separately rather than assigned to either group.
What this means
Regulators
A rural funding formula weighted by population under-serves facilities; one weighted by facility count over-serves them relative to residents. Both figures belong in the same sentence, and this payload carries them per state.
Researchers
Rural hospital share and rural population share are separate measures that rank states differently. Sorting by either alone produces a misleading ordering, so the per-state payload publishes both.
Methodology readers
The county join is the fragile step. CMS writes "MC KEAN" where USDA writes "McKean", and a naive uppercase compare drops that hospital from its state rollup. Normalization is to alphanumerics only, and the 239 hospitals still unmatched are counted rather than silently discarded.
Null hypothesis
The share of a state's hospitals located in nonmetro counties tracks the share of its population living in nonmetro counties. Rejected: nationally the two differ by a factor of about 2.5, and the gap varies widely by state, so the two measures cannot substitute for one another in a funding formula.
Denominator
Every hospital in CMS Hospital General Information with a US state address (5,366 across 50 states and DC; territories are excluded because ERS publishes no continuum code for them). Rural means the hospital's county carries USDA ERS Rural-Urban Continuum Code 4 to 9 for 2023.
Data source
Two public files, joined on a normalized county name because CMS and USDA disagree on spacing and punctuation: CMS Hospital General Information and USDA ERS Rural-Urban Continuum Codes 2023. Compute script: `analysis/rural_health_national.py`. No BigQuery and no paid API.
Pre-registered: results not yet published.
This finding is listed here before results drop. That is the project's trust contract: the null hypothesis and the computation are public first, and numbers follow. Methodology: /methodology.
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