The Maternity Units Still Open Look a Lot Like the Ones That Closed
Researchers analyzed 3,108 US hospitals that offered labor and delivery services in 2010. By the end of the study period, a significant share had stopped delivering babies. A new JAMA Health Forum study examines what distinguished the hospitals that closed from the ones still open today, and the answer is not reassuring.
Forty-one percent of hospitals still providing delivery services share the same high-risk characteristics as facilities that have already closed their maternity units. Low birth volume was the strongest single predictor of closure across both rural and urban hospitals. The findings suggest the wave of maternity unit closures that accelerated over the past decade may not be finished.
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The researchers did not treat rural and urban hospitals as interchangeable, and that distinction shapes what the data actually says about which hospitals are most vulnerable and why.
Unprofitability raised the risk of closure for rural hospitals by 12 percentage points more than it did for urban ones. For-profit ownership was associated with much higher closure risk in rural areas specifically. The researchers argue that blanket policy interventions are unlikely to work because the drivers of closure differ meaningfully by location. Rural and urban hospitals losing maternity units need different responses.
The data is a pre-acceleration snapshot: it was collected before the most recent rounds of maternity unit consolidation. The profile of a hospital at high risk for losing delivery services is now well-characterized in the literature, and the researchers say the policy window to act on that profile is narrowing.
Source: Kozhimannil et al., “Predictors of Hospital Obstetric Unit Closure,” JAMA Health Forum