A growing number of rural hospitals are closing labor and delivery units, making transportation difficult for the roughly 500,000 women that give birth at rural hospitals each year, Michelle Andrews reports for Kaiser Health News. A study by the University of Minnesota School of Public Health, published in January in the journal Health Services Research, looked at 306 rural hospitals with at least 10 births in 2010 in nine states—Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin. It found that 7.2 percent of those hospitals closed their obstetric units.
The study found that the closed services "were smaller in size, more likely to be privately owned and located in communities with lower family income, fewer obstetricians and fewer family physicians. Prenatal care was still available in 17 of 19 communities, but local women would need to travel an average of 29 additional miles to access intrapartum care," Andrews writes. (UM graphic shows smaller services were more likely to close)
Andrews writes, "There are many factors that contribute to the decline in rural hospital obstetrics services. For one thing, obstetrics units are expensive to operate, and a small rural hospital may deliver fewer than 100 babies a year. It can be difficult to staff the units as well. Small rural hospitals may not have obstetricians on staff and rely instead on local family physicians, but it can be difficult to get enough to fully provide services for a hospital, too. Nurses with obstetrics experience also can be scarce."
Paying for such services is a big issue because of meager insurance payments and Medicaid reimbursements, which are about half as much as private insurance. "Medicaid pays for slightly under half of all births in the U.S., but in rural areas the proportion is often higher," said study author Katy Kozhimannil. "Keeping a labor and delivery unit open is harder in rural areas."
Advocates say encouraging medical professionals to practice in rural areas could be one solution, Andrews writes. Another is a bipartisan bill introduced in Congress last year that "would require the federal government to designate maternity-care health professional shortage areas. Such designations exist for primary care, mental health and dental care." Another solution could be midwives, which are less expensive than physicians. "Although birthing centers and home births are on the rise, more than 98 percent of the 4 million babies that were born in 2014 made their arrival at a hospital." (Read more)
The study found that the closed services "were smaller in size, more likely to be privately owned and located in communities with lower family income, fewer obstetricians and fewer family physicians. Prenatal care was still available in 17 of 19 communities, but local women would need to travel an average of 29 additional miles to access intrapartum care," Andrews writes. (UM graphic shows smaller services were more likely to close)
Paying for such services is a big issue because of meager insurance payments and Medicaid reimbursements, which are about half as much as private insurance. "Medicaid pays for slightly under half of all births in the U.S., but in rural areas the proportion is often higher," said study author Katy Kozhimannil. "Keeping a labor and delivery unit open is harder in rural areas."
Advocates say encouraging medical professionals to practice in rural areas could be one solution, Andrews writes. Another is a bipartisan bill introduced in Congress last year that "would require the federal government to designate maternity-care health professional shortage areas. Such designations exist for primary care, mental health and dental care." Another solution could be midwives, which are less expensive than physicians. "Although birthing centers and home births are on the rise, more than 98 percent of the 4 million babies that were born in 2014 made their arrival at a hospital." (Read more)
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