The U.S. government has supported rural hospitals through direct subsidies and staff recruitment programs. However, little is known about the long-run impact of large-scale changes to rural health care. The authors explore the long-run trajectory of Appalachian counties where a coal mining union introduced a pioneering rural health care program in the 1950s, anchored by a chain of high-quality hospitals. Hospital beds per capita in counties where the union built its hospitals are persistently high through 2006, even when compared to similar counties and accounting for a variety of supply- and demand-side factors. In particular, union counties defied a national hospital consolidation trend starting in the 1980s. Results are consistent with a supply-side explanation where the scale and/or innovation of the union's investment allowed hospital markets to thrive and attract patients from a broad geography.

美国政府通过直接补贴和员工招聘计划支持农村医院。然而，人们对农村卫生保健大规模变化的长期影响知之甚少。作者探索了阿巴拉契亚县的长期发展轨迹，在 1950 年代，煤矿工会在这些县推出了开创性的农村医疗保健计划，并以一系列优质医院为基础。到 2006 年，工会建造医院的县的人均病床一直居高不下，即使与类似县相比，并考虑到各种供需方面的因素也是如此。尤其是，联合县无视 1980 年代开始的全国医院整合趋势。结果与供应方的解释一致，即工会的规模和/或创新