Establishing a rural hospital cooperative: a case study.

Rural hospitals have traditionally been the providers of health services in rural areas. In recent years, however, rural hospitals have come under increasing economic and regulatory stress. Rural hospital cooperatives represent a new level of shared management that addresses mutual problems using a horizontal organizational model. In 1987, the Western New York Rural Health Care Cooperative was established by building on fragments of associations that had existed previously. Triggered by an opportunity for grant funding, a major regional cooperative evolved which has demonstrated effective responses to a variety of problems inherent in providing rural health care. Particularly successful programs have such features as a quality assurance plan that uses cooperative-wide peer review, nursing and allied health education, physician recruitment, and the active involvement of a university medical school. This paper is a case study of the development and success of the Western New York Rural Health Care Cooperative.