Estimating Realized Access to Obstetric Care in Georgia: A Discrete Choice Modeling Analysis

Area of Science:

• Health Services Research
• Maternal Health
• Health Economics

Background:

• Obstetric unit closures in the US limit maternal care access, especially in rural areas, potentially increasing adverse outcomes due to longer travel distances or reliance on low-volume facilities.
• Understanding patient facility selection patterns is crucial for policymakers aiming to support obstetric care in underserved regions and evaluate intervention impacts.

Purpose of the Study:

• To develop and apply a revealed preference discrete choice modeling framework to estimate realized access to obstetric facilities based on patient and facility attributes.
• To evaluate the model's ability to predict low-volume facilities and regional access patterns, informing policy interventions for better patient volume distribution.

Main Methods:

• Utilized a discrete choice modeling framework, including a distance-only model, a multinomial logit model, and a latent class model, to analyze 2016-2019 Georgia birth records.
• Compared model performance in predicting low-volume facilities and regional access, identifying patient classes based on sensitivity to distance and facility attributes.
• Incorporated patient characteristics and facility attributes (e.g., level of care, rurality, health system affiliation) into the models.

Main Results:

• The latent class model demonstrated superior performance, identifying two distinct patient classes: 'less distance-sensitive' (34.5%) and 'more distance-sensitive' (65.5%).
• Patient selection of delivery facilities was significantly influenced by travel distance, facility level of care, rurality, and health system affiliation.
• Identified regional patterns of seeking care at distant or low-volume facilities, highlighting the impact of social determinants of health on facility choice.

Conclusions:

• Discrete choice modeling provides a practical tool for forecasting underutilized obstetric facilities and understanding patient access patterns.
• Maternal care interventions must consider patients' social determinants of health and heterogeneous preferences, not just geographic proximity.
• Findings can inform policies to optimize obstetric care distribution, mitigate the impact of unit closures, and improve maternal outcomes.