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Urban-rural hospital affiliations: assessing control, fit, and stakeholder issues strategically.

Urban-rural hospital affiliations are an outgrowth of both the external pressures on rural hospitals to survive and the need for urban hospitals to maintain or increase their share of the tertiary referral market. This article discusses the significant role of stakeholders in these affiliations, develops a fourfold typology of urban-rural hospital affiliations based on the notions of organizational control and fit, suggests four generic strategies for forming affiliations, and analyzes four actual cases of affiliation.