Ransomware attacks in the health care sector have more than doubled in the past five years. Among providers, hospitals experience the highest rate of operational disturbances including restricted access to servers, disrupted patient care and significant financial losses.

A new study led by the University of Minnesota School of Public Health, published in the Journal of Rural Health, finds that while ransomware attacks are more likely to occur in urban areas, the operational disruptions may have more pronounced effects on financially vulnerable rural hospitals and their patients, who are often older, in poorer health and facing pre-existing barriers to care.

Researchers gathered data on the operations of 43 rural hospitals and 117 urban hospitals that experienced ransomware attacks between 2016 and 2021. Comparing urban ransomware-attacked hospitals to their rural counterparts, the study found:

• During the first week of a ransomware attack, the volume and revenue of hospital inpatient, outpatient and emergency room visits decreased for both rural and urban hospitals.
• Rural hospital patients required further travel to the nearest hospital not experiencing a ransomware attack. The median travel time for rural patients was over 30 minutes, compared to under 10 minutes for urban patients.
• Rural hospitals experiencing ransomware attacks were smaller and less likely than urban ransomware-attacked hospitals to be part of a large health system.

"Ransomware attacks are bad news for hospitals and patients no matter where they happen, but they're especially harmful to rural hospitals and patients," said Hannah Neprash, SPH associate professor and lead author. "Preparing for cyberattacks is really a coordination challenge since it would likely require cooperation across hospitals that usually compete with each other in order to ensure everyone gets safe and effective care."

While there is a limited body of evidence on the effects of ransomware attacks on rural hospitals, this research emphasizes the need to tailor policy options to health care and hospital needs as rural hospitals are typically smaller, financially vulnerable and may need more assistance improving their cybersecurity defenses.

More information: Hannah T. Neprash et al, What happens to rural hospitals during a ransomware attack? Evidence from Medicare data, The Journal of Rural Health (2024). DOI: 10.1111/jrh.12834