55% of US Rural Hospitals Are No Longer Offer Birthing Services – Healthcare Economist

That is according to a article in JAMA based on report from the Center for Healthcare Quality and Payment Reform. The report states:

More than half (55%) of rural hospitals in the United States do not offer labor and delivery services, and in 10 states, more than two-thirds do not. Over the past decade, more than 200 rural hospitals across the country have stopped delivering babies…

In most urban areas, the travel time to a hospital with labor and delivery services is less than 20 minutes, but in rural areas, the travel time is probably at least 30 minutes, and is often 40 minutes or more.

https://ruralhospitals.chqpr.org/downloads/Rural_Maternity_Care_Crisis.pdf

Longer travel distances affect not only access to care during childbirth, but also prenatal and postnatal care.

The absence of local maternity care services is felt throughout the obstetric care process. Patients are less likely to obtain adequate prenatal or postpartum care services if they need to travel long distances.

“It’s one thing to say a mother has to drive half an hour to deliver her baby,” Miller said. “It is another thing to say that the mother has to drive half an hour every month to receive prenatal care. “They can’t be absent from work, they can’t take time away from the children.”

https://jamanetwork.com/journals/jama/fullarticle/2815499

https://ruralhospitals.chqpr.org/downloads/Rural_Maternity_Care_Crisis.pdf

Why are rural hospitals abandoning maternity care? Clearly the answer is that the reimbursement is well below its cost. Furthermore, it is difficult to find suitable staff.

Maintaining labor and delivery services requires having doctors and nurses, including nurse anesthetists or anesthesiologists, who are trained and available 24 hours a day to manage deliveries as needed. As a result, birth payments that are adequate at a large hospital are not sufficient to support maternity care at small rural hospitals with far fewer births.
“We are born around 300 babies a year, that is, an average of less than 1 per day, but we still have to have obstetrics and gynecology coverage 365 days a year, 24 hours a day, 7 days a week because babies come all the time. ”Sinek said in an interview. “Right now it is costing us $7.5 million to staff our obstetrics unit with nurses who know what they are doing and CRNAs. [certified registered nurse anesthetists] to perform anesthesia services and office staff to support that care. “All of that is really adding up, and if enough babies are not delivered to cover those costs, then we are on a downhill road.”

…fewer obstetricians and family physicians with obstetric skills are able or willing to be on call several nights and weekends each month…As a result, hospitals must employ or hire more hospital physicians or obstetrician-gynecologists.

https://jamanetwork.com/journals/jama/fullarticle/2815499

You can read the full report here.

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