Closures of rural hospitals are putting pregnant women and their babies at risk.
Reuters is reporting that data collected from hospitals, state health departments, the federal government, and rural health organizations have found that hospitals in rural communities are facing cuts to services, shuttering their maternity wards or closing down completely. Maternity wards are often the first to go in order to save on insurance and staffing costs.
Dr. Nicole Arthur, a family practice physician in Bay Minette, Alabama, was trained to avoid performing a C-section unless absolutely necessary due to increased surgery risks and recovery time. However, since going to work last year at North Baldwin Infirmary, a 70-bed facility in southern Alabama, she has changed the way she does things as a result of staff reductions.
High costs, coupled with low patient admissions, have resulted in the absence of doctors being available to administer anesthesia in the event of complications. To preclude a situation where a patient requires emergency surgery but may face a wait of 20-30 minutes for an anesthesiologist to arrive in the middle of the night, the mere suspicion that something may happen is enough for her to perform a Cesarean.
She explains, “It’s better for me to do a C-section when I suspect that something may happen. Getting the baby out healthy and happy outweighs some of the risk.”
The North Carolina Rural Health Research Program found that since 2005, 119 rural hospitals have been shuttered, 80 of those since 2010.
Between 2004 and 2014, over 200 maternity wards have closed due to higher costs, fewer births and staff shortages. According to the University of Minnesota’s Rural Health Research Center, a staggering 54 percent of rural communities across the country are without hospital-based obstetrics.
Although the Affordable Care Act was designed to take some of the pressure off of rural facilities, unpaid patient debt in those facilities has risen by 50 percent since its passage, particularly in the states that decided not to accept expanded Medicaid and the federal dollars that come with it.
Had Congress approved the GOP’s latest attempt to repeal and replace the ACA, the Chartis Center for Rural Health found that another 150 rural hospitals would have been pushed into the red. And now, Mitch McConnell is actually proposing to just repeal Obamacare and deal with replacing it with who knows what two years down the road.
Diane Calmus, government affairs and policy manager for the National Rural Health Association said, “The majority of births in rural America are paid for by Medicaid, and Medicaid is not the most generous payer. For most hospitals, it is a money losing proposition.”
When you add to that the number of C-sections performed in these facilities due to understaffing, you being to see a pattern emerge. The cost of a C-section is about 50 percent higher than a vaginal delivery, whether paid for by conventional insurance or governmental insurance. Medicaid payments for mother and newborn care for a vaginal birth is $9,131. Induced labor and the cost of a C-section have a $13,590 price tag. If you are unfortunate enough not to have health insurance or be eligible for Medicaid, it’s easy to understand why the unpaid patient debt has risen.
But the higher price tag is incidental to physicians who are trying to provide the best services for patients who would otherwise have a vaginal delivery if staffing levels were sufficient. Amy Tolliver, director of Perinatal Partnership, said, “Inductions allow the physicians to manage their case loads and timing of deliveries. We know that inductions are happening in small hospitals that have difficulty with staffing.”
The closures have a direct effect on mothers-to-be, who often have to travel long distances to get to facilities. A working mom will sometimes put off traveling distances that can be as far as 60 miles away or more in favor of earning a paycheck. Taking a day off from work and the cost of going back and forth to a distant obstetrics facility strain the resources of the rural poor.
Induced deliveries have nearly doubled since 1990 and account for approximately 23.3 percent of births. That rate is significantly higher in rural areas to combat the necessity of traveling long distances, particularly when the weather is bad.
The United States has the dubious distinction of having one of the highest infant mortality rates in developing countries at 5.8 deaths per 1,000 births. In the richest country in the world, it goes beyond shameful to downright criminal.
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