A new report found the majority of Iowa’s rural hospitals no longer have labor and delivery services.
The Center for Healthcare Quality and Payment Reform analyzed federal data and found, as of last month, 61% of rural Iowa hospitals no longer have OB care, and of the 36 rural hospitals still providing care, 58% were losing money on patient services overall.
Many hospitals are shuttering their units because insurance companies and Medicaid aren't reimbursing hospitals enough to cover the cost of births, Harold Miller, the president and CEO of Center for Healthcare Quality and Payment Reform, said.
"We've suggested that they also need to pay differently," he said. "Rather than simply paying for each birth, they need to be paying the hospital to be able to support the availability of the appropriate staff to do that."
Policymakers also need to find ways to recruit more providers to work in rural areas at a national level, he said.
The data show that it's likely more hospitals will shutter units as they continue to face financial struggles, and it’s really hard to reopen OB units once they close, Miller said.
"It's really important to try to prevent more of them from closing now," he said, "and with the warning signs that this indicates that this problem is growing right now, we could be seeing a lot more closing if we don't have immediate action."
Research from the University of Minnesota shows the loss of labor and delivery units in more remote rural counties correlates with a decrease in prenatal care and an increase in out-of-hospital births.
The report estimated the median time pregnant Iowans who don't have local OB care would have to drive to an alternative unit is 30 minutes.
But Miller said the issues with driving further for OB care span way past just the moments surrounding the birth.
"If the hospital is not delivering having maternity care services anymore, it may not just be that it's not delivering babies, it may also not have adequate prenatal and postpartum care," he said, "which means that mothers may get into more trouble during pregnancy or after they deliver when they go back home as they have delivered somewhere else."
