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Effect of Hospital Obstetrics Unit Closures on Travel Time to Obstetric Care in the United States
Brittany L Ranchoff1, Aaron Kofner1, Olesya Baker1
1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; RAND Corp, Arlington, Virginia; Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida; and National Rural Health Association, Washington, DC.
Objective:
To examine the effects of hospital obstetric unit closures on travel time to the nearest hospital-based obstetric services.
Methods:
The 2010-2021 American Hospital Association Annual Survey and Centers for Medicare & Medicaid Services Provider of Services files were used to determine hospital-based obstetric service availability between 2010 and 2021 and classified counties into three categories: 1) never had in-county obstetric services, 2) had continual in-county obstetric services, and 3) lost all in-county obstetric services. Our unit of analysis was census tracts, and county-level obstetric service availability defined our independent variable. Our sample included 60,516 tracts (726,192 tract-years) across 3,033 continental U.S. counties. We compared tracts in counties that lost all obstetric services between 2010 and 2021 with tracts in counties with continual services between 2010 and 2021 (primary control group). Our outcome was travel time in minutes from tract centroids to the nearest obstetric services. To evaluate changes in travel time after obstetric unit closures, we used a staggered difference-in-differences study design by using the Callaway and Sant'Anna difference-in-differences model, overall and by rurality.
Results:
Overall, 2.7% of tracts were in a county that lost all hospital-based obstetric services between 2010 and 2021, 89.2% were in a county with continual obstetric services, and 8.2% were in a county that never had obstetric services between 2010 and 2021. The unadjusted and adjusted models generated comparable results, showing that obstetric unit closures were associated with a significant increase of 13.8 minutes (95% CI, 13.1-14.4) on average in travel time to the nearest obstetric hospital. Travel time increased more in rural than urban areas (16.9 minutes [95% CI, 15.9-17.8] versus 10.3 minutes [95% CI, 9.4-11.1]).
Conclusion:
After hospital obstetric unit closures, travel time to the nearest obstetric services increased, especially in rural areas. The increased travel time presents a barrier to obstetric care because almost all U.S. births occur in hospitals.
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