A 7.2 percent closure rate was observed by researchers; critical access hospitals are more likely to close their OB units than other rural hospitals.
Rural hospitals that shut down obstetrics (OB) services between 2010 and 2014 were smaller and more likely to be privately owned and located in low-income communities, according to a new study.
A telephone survey of 263 rural hospitals in nine states found that 19, or 7.2 % had closed OB units. The study was conducted between September 2013 and March 2014 in Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin.
Hospitals cited staffing, low volume, and low reimbursement rates as the top three factors in the decision to close, according to findings published in the journal Health Service Research.
The University of Minnesota researchers found that critical access hospitals were more likely to close OB units than other rural hospitals. Fifteen of the 19 hospitals that closed unit reported that the most common reason for closing was difficulty finding staff including "retention, recruitment, and liability issues surrounding obstetricians."
Two of the closed hospitals reported women in their communities were left with no local access to prenatal care. Instead they would need to travel 25.4 miles and 40.8 miles to the nearest hospitals where OB services are available.
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The hospitals reporting that prenatal service were available locally noted that patients need to travel an average of 29 miles for obstetric care.
The researchers note that public hospitals may be less likely than private hospitals to close units because of the "focus on community needs."
They also suggest that a range of additional factors may play into a decision to close a unit, including "leadership, political environments, the dynamics of the OB practice model, and patient-provider relationships."
Among the hospitals that closed their obstetric units, the chief reasons for closure were:
- Difficulty in staffing the unit, including retention, recruitment, and liability issues surrounding obstetricians
- Low birth volume
- Low reimbursement
- Other financial issues, such as surgical and anesthesia coverage and the cost of operating the units, and budget cuts
The researchers note that the fact that most women continued to have access to prenatal is "encouraging," but suggest the need for better communication between local providers and distant hospitals.
"Ongoing efforts should focus on encouraging linkages between maternity care providers and hospitals in perinatal systems of care, including using telemedicine and health information technology to help ensure continuity of maternity care," they conclude.