Relationship Between Rural Hospital Bypass and Obstetric Unit Closures

A key factor driving low patient volumes at rural hospitals is hospital bypass – when rural residents “bypass” their nearest hospital and seek care farther from home. For hospital administrators, community leaders, and policy makers, rural hospital bypass is important because it reduces hospital profitability, which can lead to closure and make it difficult for surviving hospitals to provide high-quality care. Yet, there is little evidence on the extent of hospital bypass for obstetric services and no evidence on how hospital bypass is related to obstetric unit closures.

Using data from our obstetric care status database and national commercial claims data from the Health Care Cost Institute (HCCI), this project will identify rural and urban hospitals that closed their obstetric units and assess how often obstetric patients bypassed those hospitals in the years prior to closure. We will compare (1) bypass of hospitals that closed their obstetric units, focusing on the years before closure and (2) rates of bypass of statistically similar hospitals that kept their obstetric units open over the same timeframe. Separate comparisons will be done for subgroups of hospitals that vary in rurality (urban, rural, rural micropolitan, rural non-core) and type [Critical Access Hospital (CAH), Prospective Payment Hospital (PPS)]. Among rural hospitals, we will additionally characterize the types of patients who bypassed hospitals that closed their obstetric units versus patients who gave birth at these hospitals, again focusing on the years prior to closure.