Long-Term Effects of Ransomware Attacks on Rural and Safety-Net Hospitals

/Abstract: Ransomware attacks are devastating human-made disasters that increasingly afflict the health care sector. From 2016 to 2023, the number of ransomware attacks in health care increased nearly five-fold. During a ransomware attack, cybercriminals infiltrate an electronic system, install malicious software to encrypt data, and demand a ransom to restore functionality. Ransomware attacks are financially devastating for hospitals – particularly rural and safety-net hospitals that are more likely to be in dire financial straits prior to the attack. To recover financially, hospitals may economize in ways that harm access and quality of care. We propose the first study of long-term effects of cyberattacks in health care – focusing specifically on how ransomware attacks affect populations experiencing health care disparities. To do this, we will use data on hospital ransomware attacks from the Tracking Healthcare Ransomware Events and Traits (THREAT) Database. By linking the THREAT database to Medicare data, we will measure access to and quality of hospital care. We will then use a quasi-experimental stacked difference-in-differences research design to execute the analyses proposed in Aims 1 and 2. Aim 1 will quantify the long-term effects of ransomware attacks on access to care at rural and safety-net hospitals. We hypothesize that hospitals reduce access to unprofitable services (e.g., inpatient psychiatric care) and treat fewer publicly insured patients, following a ransomware attack. Aim 2 will quantify the long-term effects of ransomware attacks on safety and quality of care at rural and safety-net hospitals. We hypothesize that hospitals reduce their quality of care in ways that jeopardize patient safety, following a ransomware attack. Finally, in Aim 3 we will conduct a novel survey of physicians at ransomware-attacked hospitals. Results from this survey will help to minimize the harm of future cyberattacks by identifying best practices that promote hospital functioning and care delivery during an attack. This study responds directly to PAR-24-109, specifically addressing the National Institute on Aging’s interest in research focusing on the long-term impacts of disasters on health care systems serving older populations experiencing disparities. Results will inform ongoing federal policy debates on cybersecurity in health care – and will also inform organization-level planning, by identifying strategies of safe and effective health care delivery during cyberattacks. Project Number: 1R01AG094902-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Hannah Neprash | Institution: UNIVERSITY OF MINNESOTA, MINNEAPOLIS, MN | Award Amount: $573,566 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 HSS-Q (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11206760