A new analysis underscores concerns about how federal aid has been given to healthcare facilities under the Provider Relief Fund, a $ 175 billion program that has been harshly criticized for providing so much money to the richest US hospitals.
The study, published on Friday in the JAMA Health Forum, shows that more money went to hospitals that were in strong financial shape before the pandemic than to hospitals with weaker balance sheets and less facilities.
Small rural hospitals, known as critical access hospitals, received less funding, according to a study by researchers at RAND Corporation, a nonprofit group. These rural facilities often operate under extremely tight budget constraints, and some have been closed or acquired over the course of the pandemic.
More help also flowed to the hospitals that cared for the greatest number of Covid patients, many of which were large academic medical centers and large hospitals.
“There were big differences in the level of funding from each hospital,” said Christopher M. Whaley, one of the study’s authors, in an interview.
Analysis of 952 hospitals found that 24 percent received less than $ 5 million, while 8 percent received more than $ 50 million. Overall, the small rural hospitals received 40 percent less funding than their larger and more affluent counterparts.
The researchers did not take into account the $ 24 billion specifically earmarked for rural and safety net hospitals in underserved areas that may have helped these organizations.
Congress approved the aid to cushion hospital losses during the pandemic as patients stayed away and facilities could not perform lucrative surgeries and procedures.
But some of the hospitals that received hundreds of millions of dollars in federal funding kept buying during the Covid crisis, devouring weaker hospitals and groups of doctors. Some big chains, including HCA Healthcare and the Mayo Clinic, chose to give at least some of the money back.
The devastation caused by the Delta variant has further strained many hospitals, overwhelmed intensive care units and forced some to renew delays in elective treatments.
A September report commissioned by the American Hospital Association predicted a third of these will have operating losses in 2021. Hospitals say they treat sicker patients, many of whom delayed treatment earlier in the pandemic, and pay more for staff, supplies and medication.
Dr. Whaley said the greater flow of money to hospitals in strong financial shape calls into question “the purpose of those financial resources,” noting that some institutions have massive foundations and substantial assets. In contrast, rural hospitals, which received the least amount of help, were already financially tight at the time of the pandemic.
“Policy makers should continue to ensure that these types of hospitals receive adequate funding, possibly with additional rounds of funding,” the researchers wrote.