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One state's response to the malpractice insurance crisis: North Carolina's Rural Obstetrical Care Incentive Program.

D H Taylor¹, T C Ricketts, J L Berman

¹North Carolina Rural Health Research Program, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590.

Public Health Reports (Washington, D.C. : 1974)

|September 11, 1992

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North Carolina

Area of Science:

Health Services Research
Rural Health Policy
Medical Malpractice Insurance

Background:

Rural obstetrical services declined significantly in North Carolina (1985-89) due to rising malpractice insurance costs.
This decline threatened access to essential maternal healthcare in underserved areas.
Governmental and policy interventions were necessary to address this critical healthcare gap.

Purpose of the Study:

To evaluate the effectiveness of the Rural Obstetrical Care Incentive (ROCI) Program in maintaining or increasing obstetrical care access in rural North Carolina.
To analyze the program's impact on healthcare providers and patient access despite budgetary constraints.
To provide insights for national policymakers regarding rural healthcare access and malpractice insurance challenges.

Main Methods:

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Qualitative assessment through site visits to local health departments in participating counties.
Quantitative data analysis from the North Carolina Division of Maternal and Child Health.
Examination of program implementation, funding, and eligibility criteria.

Main Results:

The Rural Obstetrical Care Incentive (ROCI) Program, offering malpractice insurance subsidies, has successfully supported obstetrical care provision in rural North Carolina.
Program funding increased substantially, demonstrating commitment despite state budget limitations.
Certified nurse midwives became eligible for subsidies, expanding program reach.

Conclusions:

The ROCI Program serves as an innovative model for addressing rural obstetrical care shortages exacerbated by malpractice insurance rates.
Decentralized, county-level decision-making is a key feature of this successful state-level intervention.
The program's success offers valuable lessons for other states facing similar rural healthcare access challenges.