OBJECTIVES: Texas is the state with the most rural hospital closures, severely limiting access to care. One solution is to diversify services in rural areas. The objective of this study is to evaluate mental health utilization and incurred costs in rural vs. urban hospitals in Texas.

METHODS: Texas Hospital Association (THA) dataset used in this study contains both de-identified patient and hospital-level data from Texas hospitals that report to THA in 2019. To identify mental health services and costs, we used both ICD-10 (codes with “F”) and revenue codes, respectively. Other variables such as insurance and patient demographics were provided by the dataset. Descriptive statistics, logistic regressions, and Chi-Square analysis was conducted using SAS 9.4.

RESULTS: Of all hospital visits in 2019, inpatient visits had the highest mental health-related visits (2.9%) followed by emergency room (ER) at 2.67%. For outpatient and inpatient hospitals, median charges were the highest in radiology for rural, whereas therapy and lab had the highest costs in urban areas. Although most mental health visits were from Whites, adults, and males, Asians, older adults (>65), and females consistently incurred the highest costs. For inpatient urban hospitals, 19% of all mental health charges were paid by the hospital, and this increased to 45.9% for ER. Average charges were significantly 25% less for outpatient, 21% less for ER, and 9% more for inpatient in rural vs. urban hospitals.

CONCLUSIONS: Although urban areas incurred more charity costs, rural areas had lower charges, indicating that rural hospitals may be charging less for similar services. This reveals an area of improvement to help maintain access to care and profitability in rural areas. Clinicians and policy makers can improve health equity by understanding drivers and studying solutions to barriers of healthcare access and diversifying services in rural hospitals.