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Vinson Fellow explores how service area constraints affect rural hospitals

May 2, 2019

By Christina Chu

Christina Chu

Vinson Fellow explores how service area constraints affect rural hospitals

This semester has been an exciting one as my research project progressed from abstract proposal to concrete findings. I set out to learn more about the rural healthcare crisis and the disconnect between metro-area healthcare systems that have billion-dollar revenue streams and rural hospitals that are increasingly being shut down for financial reasons.

I explored the statutory limitations of county hospital authorities and learned how a variety of constraints encourages the growth of nonprofit hospital systems around the state. Consequently, I have gained a much deeper understanding of the connections that my project has to the greater, more systemic rural healthcare crisis and the laws in existence that affect it.

As I looked into specific stakeholders in the process, I was pleasantly surprised by the strong community support I received throughout my work. A number of experts in the field have reached out and been enthusiastic in talking with me about their experiences and perspectives, and this has allowed me to hear a wide range of voices. Through these conversations, my project has been guided into an analysis of the reasons for the shift to nonprofit systems and an examination of the solutions that have been proposed to maximize efficiency in healthcare.

In researching case studies around Georgia, I have observed a common thread. Regardless of the location of the hospital system, a major factor shared in the transition to nonprofit hospitals was the geographic limitation hospital authorities experience, as regulated by the law. In an increasingly competitive market for healthcare, state law restricts local hospital authorities to a service area consisting of their home county and their contiguous counties. With so many hospital systems shifting to nonprofit status, those governed by the more traditional structure are at an economic disadvantage because they cannot expand their service areas in the same way. The expansion of the service area that a hospital can reach comes with many benefits, including allowing for greater specialization and shorter travel time for patients.

These findings helped contextualize the transition to nonprofit systems for me, and I look forward to synthesizing my research into meaningful conclusions in the final steps of my research.


Christina is a second-year undergraduate Honors student from Kennesaw. She is pursuing bachelor's degrees in international affairs and political science, minoring in Spanish and has begun working on a master’s degree in international policy. She has served as the political action chair with the Hispanic Student Association, trained as a site leader for IMPACT Alternative Spring Break trips and serves as a Goizueta Ambassador for the UGA Office of Undergraduate Admissions and assistant senior editor for the Georgia Political Review.