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Rural Health Care in Crisis: Hospitals Close Labor and Delivery Units

Facilities struggle to find sufficient staff and revenue

Approximately 500,000 women give birth each year in rural hospitals, and yet access to labor and delivery units has been declining, according to a report from Kaiser Health News. Comprehensive figures are spotty, but an analysis of 306 rural hospitals in nine states with large rural populations found that 7.2% closed their obstetrics units between 2010 and 2014.

The new findings were published in the January issue of Health Services Research.

“The fact that closures continue happening—over time that means the nearest hospital gets further and further away,” said co-author Dr. Katy Kozhimannil, an associate professor at the University of Minnesota School of Public Health.

Many factors contribute to the decline in rural hospital obstetrics services, the authors say. 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 may have to rely on local family physicians, but it can be difficult to find enough doctors to fully provide services for a hospital. Nurses with obstetrics experience can also be scarce.

Meanwhile, bringing in the revenue needed to cover the costs involved in maintaining the units can be difficult because insurance payments are often low. Medicaid pays for slightly under half of all births in the U.S., but in rural areas the proportion is often higher, Kozhimannil said. Since Medicaid pays about half as much as private insurance for childbirth, “the financial aspect of keeping a labor and delivery unit open is harder in rural areas,” she said.

Advocates say a number of initiatives could help bolster labor and delivery services in rural areas, according to the authors.

Encouraging medical professionals to move to rural areas is key, they say. A bipartisan bill introduced in Congress last year, for example, would require the federal government to designate maternity care health professional shortage areas. Such designations exist for primary care, mental health, and dental care. The National Health Services Corps awards scholarships and provides loan repayments to primary care providers who commit to serving for at least two years in a designated shortage area. Once they get to a community and put down some roots, the hope is they’ll stay.

Expanding the use of midwives and birthing centers could be cost-effective since they are generally less expensive than physicians and hospital obstetric units, according to the authors. Although birthing centers and home births are on the rise, more than 98% of the four million babies that were born in 2014 made their arrival at a hospital.

Source: Kaiser Health News; February 23, 2016.

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