Final week, Keck Medication of USC introduced the closure of USC Verdugo Hills Hospital obstetric providers on Nov. 20. They cited a 40% decline in deliveries over the previous decade inside “our group” and the ensuing monetary impact on the hospital as causes for the choice. Whereas this justification seems cheap at first look, it conceals an unsettling pattern with important implications for maternal well being.
The closing of hospital labor and supply items is a nationwide pattern, leading to “maternity care deserts.” The closures primarily have an effect on sufferers with Medicaid insurance coverage, which pays for greater than 40% of deliveries in the USA, and thru Medi-Cal, greater than 50% of deliveries in California. Unequal entry to obstetric care contributes to America’s shamefully excessive maternal mortality charge which, at 22 maternal deaths per 100,000 dwell births in 2022, was double or triple the speed of peer nations.
Obstetric care is completely different from many different kinds of healthcare in its unpredictability. Infants don’t arrive on anybody’s schedule, and the busyness of labor and supply items can wax and wane accordingly. For docs to look after laboring moms and their infants safely, hospitals should be staffed for the opportunity of a sudden abundance of sufferers requiring emergency care.
The fashionable fee-for-service healthcare mannequin, which pushes hospitals to maximise effectivity and scale back staffing, treats the resiliency essential for delivering infants as a drag on their backside line. On this mannequin, hospitals should fund round the clock capability however are solely reimbursed when their amenities and workers are in motion. So if not sufficient deliveries are taking place, bills outweigh reimbursement. This drives hospitals to get out of the newborn supply enterprise altogether.
California has skilled a better charge of obstetric unit closures than different states, and it continues to speed up. Greater than 46 labor and supply departments closed within the state between 2012 and 2023, with 60% occurring throughout the final three years. These closures usually are not restricted to sparsely populated rural areas: 17 had been inside Los Angeles County, leading to a native charge of closures that far outpaces the declining start charge. This 12 months, 5 extra California hospitals have stopped offering obstetric care, and USC Verdugo Hills Hospital would be the fifth in L.A. County to shut labor and supply inside a two-year interval.
Healthcare and medical profit directors speak of scaling and consolidation, of concentrating obstetric care at fewer hospitals in order that there shall be sufficient deliveries to cowl the expense of remaining open. This can solely work if we assume that market forces will type out the stability between provide and demand so sufficient labor and supply departments stay open to satisfy demand. However such forces solely work if costs are dynamic and aware of modifications in provide. Insurance coverage suppliers, particularly Medicaid and Medi-Cal, haven’t proven such a flexibility.
Medi-Cal, the Medicaid program in California, has reimbursement charges for obstetric care which can be fifth lowest within the nation. In our state, even busy labor and supply departments that care primarily for Medicaid sufferers don’t break even. South L.A.’s Martin Luther King Jr. Group Hospital is struggling to remain open regardless of growing its quantity of obstetric sufferers as different Los Angeles labor and supply items have closed. This exhibits that the quantity paid by Medi-Cal is beneath the market price of offering obstetric care. This deficit is on the core of the California closures.
There are not less than two paths ahead.
The primary is to extend Medi-Cal’s reimbursement of every delivered affected person. The second would require instantly regulating and subsidizing the upkeep of labor and supply items the best way the state does for emergency rooms. Both strategy shall be pricey, as a result of offering protected, fashionable, evidence-based obstetric care is pricey.
Reproductive freedom is far within the information this marketing campaign season. It ought to embody cheap, protected and reliable entry to labor and supply providers.
Anna Reinert is an assistant professor of medical obstetrics and gynecology at USC’s Keck College of Medication.
