It’s very glaring that Maternity Wards are closing in America but why is it? A new report from the policy firm Center for Healthcare Quality and Payment Reform found that fewer than half of rural hospitals in the U.S. still offer labor and delivery care. The report also found that hundreds more rural hospitals may shutter these services due to financial challenges.
The decline in rural maternity care has been a growing problem for years. In 2017, the American Hospital Association reported that 89 obstetric units closed in rural hospitals between 2015 and 2019.
In the past ten years, over 200 rural hospitals across the United States have been forced to discontinue their labor and delivery services. This alarming trend has left only 45% of rural hospitals equipped to handle childbirth, according to a report by the Center for Healthcare Quality & Payment Reform. In ten states, the proportion of hospitals offering maternity care has dwindled to below one-third.
For pregnant women residing in rural communities, the absence of nearby maternity services can translate into lengthy travel times to reach alternative medical facilities. In these areas, such journeys typically take upwards of 40 minutes, compared to the average 20-minute commute in urban areas.
This delay in reaching appropriate care can significantly increase the risk of complications and fatalities for both mothers and their newborns. Additionally, the lack of local maternity care services often leads to reduced access to essential prenatal and postpartum care.
Factors Contributing To The Decline In Rural Maternity Care
There are a number of factors contributing to the decline in rural maternity care, including:
- Decreasing numbers of births: The birth rate in the United States has been declining for decades, and this trend is particularly pronounced in rural areas.
- Staffing issues: It can be difficult to recruit and retain qualified OB-GYNs and midwives in rural areas.
- Low reimbursement from Medicaid: Medicaid is the health insurance program for low-income people, and it is the primary source of payment for many rural maternity care providers. However, Medicaid reimbursements for maternity care are often low.
- Financial distress: Many rural hospitals are struggling financially, and they often see maternity care as a non-essential service that they can cut.
The closure of rural maternity care units has a number of negative consequences, including:
- Increased travel distances for pregnant women: Pregnant women in rural areas may have to travel long distances to give birth, which can be dangerous if they experience complications.
- Increased risk of maternal and infant mortality: Studies have shown that maternal and infant mortality rates are higher in areas with limited access to maternity care.
- Decreased access to prenatal and postpartum care: Rural hospitals that close their maternity units often also reduce or eliminate prenatal and postpartum care services.
There is a growing movement to address the decline in rural maternity care. A number of states have passed laws to increase Medicaid reimbursements for maternity care, and there are also a number of private and non-profit organizations working to support rural maternity care providers.
However, more needs to be done to ensure that pregnant women in rural areas have access to safe and quality maternity care.
Financial Struggles of Rural Maternity Care
Rural hospitals are facing financial difficulties when it comes to providing obstetric care. The primary reason for this lies in the inadequate reimbursement rates from private insurance plans. These plans often pay less than the actual cost of delivering these services, leaving hospitals to cover the shortfall. While losses from Medicaid patients also contribute to the financial strain, the impact of private insurance plans is far more significant.
In an effort to stay afloat, rural hospitals may resort to eliminating maternity care services altogether to prevent complete closure. The report proposes that health plans should be mandated to provide reimbursement that covers the full cost of perinatal care, labor and delivery assistance, anesthesia services (particularly in C-section cases), and telemedicine consultations from specialists for complex deliveries.
Further compounding the financial woes is the fact that rural hospitals only receive payment when they actually deliver a baby. Despite having to maintain staff and readiness to deliver at any moment, hospitals face financial losses if the number of pregnancies falls short of expectations. Even if reimbursement rates were adequate for a higher number of births, the current fee-based system still leaves hospitals vulnerable.
The report suggests adopting a Standby Capacity Payment approach, where private insurers and Medicaid would compensate hospitals for each insured woman of childbearing age residing in the community. This shift away from the fee-based system could provide much-needed financial stability for rural maternity care providers.
With over a third of rural hospitals reporting losses on patient services, the crisis in rural maternity care is likely to worsen without significant intervention. Implementing the proposed Standby Capacity Payment system could help alleviate the financial burden and ensure the continued availability of essential maternity care services in rural communities.
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What Should Be Done To Address The Decline In Rural Maternity Care?
The decline in rural maternity care is a complex issue with no easy solutions. However, there are a number of policy and programmatic interventions that could help to address the problem.
1. Increase Medicaid reimbursements for maternity care
Medicaid is the primary source of payment for many rural maternity care providers. However, Medicaid reimbursements for maternity care are often low. This makes it difficult for rural hospitals to afford to provide maternity care services. Increasing Medicaid reimbursements for maternity care would make it more financially feasible for rural hospitals to provide these services.
2. Invest in the recruitment and retention of OB-GYNs and midwives in rural areas
There is a shortage of OB-GYNs and midwives in rural areas. This makes it difficult to recruit and retain qualified providers to rural maternity care units. There are a number of things that can be done to address this shortage, including:
- Offering scholarships and loan forgiveness programs for OB-GYNs and midwives who agree to practice in rural areas.
- Developing training programs for OB-GYNs and midwives in rural areas.
- Increasing salaries for OB-GYNs and midwives in rural areas.
3. Support innovative models of maternity care delivery
There are a number of innovative models of maternity care delivery that could help to improve access to care in rural areas. These models include:
- Telehealth services that allow pregnant women to consult with providers remotely.
- Midwifery-led care, which has been shown to be safe and effective for low-risk pregnancies.
- Birth centers, which are non-hospital facilities that offer maternity care services.
4. Improve access to transportation
Pregnant women in rural areas may have to travel long distances to give birth. This can be a barrier to care, especially for those who do not have access to reliable transportation. There are a number of things that can be done to improve access to transportation for pregnant women in rural areas, including:
- Providing transportation vouchers or subsidies.
- Developing public transportation routes to rural maternity care providers.
- Partnering with community organizations to provide transportation services.
5. Address the root causes of the decline in rural hospitals
The decline in rural maternity care is part of a broader trend of rural hospital closures. In order to address this issue, it is important to address the root causes of rural hospital closures. These causes include:
- The decline in the rural population.
- The increasing cost of healthcare.
- The consolidation of the healthcare industry.
Addressing these root causes will require a multi-pronged approach that includes:
- Investing in rural economic development.
- Reforming the healthcare system to make it more affordable and accessible.
- Supporting local and independent healthcare providers.
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