Hospitals across America are closing their OB units, decreasing access to obstetrics services and— according to researchers—increasing rates of out-of-hospital births, preterm births, and infant mortality.
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Rural hospitals have been particularly affected. As of 2014, 54% of rural counties in the United States lacked obstetrics services. But community hospitals in urban regions are also closing, with three Chicago-area labor and delivery units having closed over the last year and a half alone.
The main driver of these closures is often cost-saving efforts, given both stagnant delivery volumes and a challenging, Medicaid-heavy payer mix.
To help quantify the immediate impact of OB unit closure for both patients and health systems, we analyzed patient drive time and system market share over four years of state data for one rural and one urban hospital that suspended OB services. Here's what we found through these case studies:
1. Rural OB unit closure increased patient drive time 26%, adding an extra 9 miles of travel
We used a weighted average to compare drive time for women in the primary service area  of a rural hospital in the years before and after OB unit closure. This particular facility was also a critical access hospital and housed the only labor and delivery unit in its respective county.
We found that patient drive time increased by 10 minutes following the closure of the hospital's OB unit, with the average distance traveled rising to 40 miles. This represents a 26% increase in patient drive time and a nearly 29% increase in patient travel distance.
These findings underscore an important consideration for providers. While women will travel to give birth, systems should reflect on how far they should drive to deliver given the confirmed impact of closure on access and associated birth complications.
2. Urban OB unit closure decreased system market share but did not affect access
Using the same methodology for patients in the primary service area  of an urban hospital before and after unit closure, we found there was little to no effect on patient access. Average drive time increased by a matter of seconds, with women in both scenarios needing to travel only seven miles to reach a labor and delivery unit.
Since this community hospital was part of a larger health system that aimed to redirect OB volumes to an affiliated site, we also examined whether market share increased at this affiliate following closure. Specifically, we assumed the closed unit would have captured the same share of market OB volumes in the year after closure as it did the year prior. We then compared this volume estimate, which the system aimed to redirect, to the affiliated site's growth in OB share. Assuming all excess volumes captured at the affiliated site were due to redirected patients (as opposed to share captured from competitors), we found that, at best, the affiliated site captured a mere 30% of the OB cases that would have been seen at the closed unit.
While systems likely expect to lose some share when they suspend a service, this finding suggests that they may actually lose the majority of volumes from a closed delivery unit and should prepare to either launch robust OB patient redirection efforts or forfeit almost all of a closed unit's share.
Overall, various factors can influence a hospital's decision to cease OB services. But before you close an OB unit, consider how you may directly impact both patient access and your share of delivery volumes.
 Primary service area refers to patient zip codes comprising 80% of the hospital's OB volumes prior to closure.
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