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The Patient Protection and Affordable Care Act of 2010 (PPACA) expanded rural Medicaid and Medicare coverage. However, factors that contribute to productivity growth in hospital-based rural health clinics are less known. This book makes a contribution by investigating the impact of organizational factors on productivity growth, while recognizing that contextual factors also affect productivity growth rates. For the years 2005 to 2008, hospital-based rural health clinics in the US showed significant growth in productivity. Prospective payment system was negatively related with productivity growth rates. Newer facilities had higher productivity. Facilities in proximity to urban areas had higher productivity. Physician availability was positively related to productivity. Therefore, specific provisions of PPACA to attract and retain physicians to rural areas and expand rural health coverage need to be implemented. This book would benefit policy makers, practitioners and researchers engaged in rural health services.