With the majority of rural hospitals in the United States no longer providing labor and delivery services, pregnant women face an increased risk of complications and death.
Over the past decade, more than 200 rural hospitals nationwide have stopped offering labor and delivery services.
Only 45% of the rural hospitals are now delivering babies, according to the Center for Healthcare Quality & Payment Reform report. In ten states, less than one-third provide these services.
If the closest hospital does not offer labor and delivery services, a pregnant woman may have to travel to a different medical facility to deliver her baby. In rural communities, travel usually takes 40 minutes or more, compared to approximately 20 minutes in most urban areas.
The lack of local maternity care services increases the risk of complications and death for both mothers and babies. Moreover, women are less likely to obtain adequate prenatal and postpartum care when it is unavailable locally.
Why are hospitals losing money?
Rural hospitals typically lose money on obstetric care, mostly because private insurance plans pay them less than it costs to deliver the services. They also lose money from Medicaid patients, but losses from private plans have the most significant impact.
As a result, rural hospitals may decide to eliminate maternity care to avoid closing entirely.
According to the report, health plans should be required to pay amounts that cover the cost of perinatal care, assistance during labor and delivery, anesthesia services, such as in the case of C-Sections, and telemedicine assistance from specialists for complex cases.
Moreover, a rural hospital is only paid when it provides a service, despite having to be staffed and ready to deliver a baby at all times. This means that if there are fewer pregnancies than expected, the hospital will lose money, even if payments would have been adequate for a larger number of births.
The report suggests moving from a fee-based approach to Standby Capacity Payment, in which private insurers and Medicaid would pay the hospital for each insured woman of childbearing age living in the community.
The rural maternity care crisis in the U.S. may only deepen, as more than one-third of the rural hospitals reported losing money on patient services.
- Center for Healthcare Quality & Payment Reform. The Crisis in Rural Maternity Care.