Working Paper: NBER ID: w30141
Authors: Stefanie J. Fischer; Heather Royer; Corey D. White
Abstract: Over the last few decades, health care services in the United States have become more geographically centralized. We study how the loss of hospital-based obstetric units in over 400 counties affect maternal and infant health via a difference-in-differences design. We find that closures lead mothers to experience a significant change in birth procedures such as inductions and C-sections. In contrast to concerns voiced in the public discourse, the effects on a range of maternal and infant health outcomes are negligible or slightly beneficial. While women travel farther to receive care, closures induce women to receive higher quality care.
Keywords: health care; obstetric unit closures; maternal health; infant health
JEL Codes: I18; I38; J08; J13; J18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Closure of obstetric units (J63) | Decrease in likelihood of women delivering in their county of residence (J19) |
| Closure of obstetric units (J63) | Fewer prenatal care visits per mother (J13) |
| Closure of obstetric units (J63) | Increase in likelihood of scheduled inductions (J19) |
| Closure of obstetric units (J63) | Reduction in likelihood of cesarean sections (J19) |
| Closure of obstetric units (J63) | Improvement in maternal morbidity (I14) |
| Closure of obstetric units (J63) | Reallocation of mothers to hospitals with lower cesarean rates (J19) |
| Reallocation of mothers to hospitals with lower cesarean rates (J19) | Higher quality metrics (L15) |
| Closure of obstetric units (J63) | Increase in likelihood of having a neonatal intensive care unit (J13) |