For a long time, healthcare providers in the U.S. have been putting band-aids on the problem of maternity care deserts, propping up existing services for pregnant women and new mothers with temporary fixes.
A DECLINING BIRTH RATE
The U.S. birth rate is in steady decline. Women are having fewer children, and they’re having them later in life, which automatically puts them at higher risk for pregnancy complications. The declining birth rate is especially a problem for rural hospitals, many of which aren’t meeting the required number of deliveries per year to meet safety standards. Because of that reality, they’re being forced to shut down their maternity wards.
The declining birth rate also means that not enough children are being born to replace the Baby Boom generation as they hit retirement age, which is feeding the growing physician shortage.
FINANCIAL DISPARITIES
Even if physician numbers were at replacement levels, the cost of education and massive student loan debts encourage new doctors to pursue higher-salaried positions, which are more typical at hospitals that serve wealthier communities. Hospitals in under-resourced areas have less to offer new doctors in terms of equipment, support, and quality of life.
They also serve a majority of Medicaid and non-insured patients, which makes it harder to keep the doors open on maternity wards, whose cost of upkeep can be substantial. If a significant proportion of patients are uninsured or have lower-paying insurance plans, it can impact the financial health of the practice.
There’s a strong correlation between insurance coverage and socioeconomic status as well. Patients in under-resourced communities tend to struggle disproportionately from social determinants of health risks, leading to a lack of comprehensive and adequate care. In turn that leads to extensive medical interventions or complications, which also strain resources and revenues. So what can be done?
QUICK FIXES
A few quick-fix solutions can provide temporary relief:
1. Education reform. Implementing a tuition remission program for doctors, where education costs are reduced or eliminated in exchange for dedicating a certain number of years to serving in underserved areas, could incentivize more physicians to practice in these areas.
2. Simplifying the funding application process. One way the government has responded to hospitals’ and health systems’ financial needs is by funding grants to close revenue gaps. While some gatekeeping is certainly necessary, the process to apply for this funding is extremely complex, frequently occurs in a tight timeline, and requires dedicated and informed staff that many of the most needy and deserving practices simply do not have. The government needs to simplify the process and take a more supportive role in helping eligible practices apply.
3. Incentivizing Medicaid capture. Several states have implemented pay-for-performance structures that reward health plans and providers for meeting quality standards in their Medicaid populations. This is a viable strategy for pregnancy care, which benefits from being a defined episode with well-established care measures.
LONG-TERM SOLUTIONS
Many longer-term solutions start with using telemedicine and digital health services. These were initially temporary fixes during the pandemic, but many have proven to improve healthcare quality and access. Consumers have an appetite for digital healthcare, and providers are willing to adopt it if they can bypass some of the challenges of reimbursement and implementation. One academic study published in December 2022 states that use of telemedicine-based care:
1. Has grown in the U.S. due to COVID-19 and will stay important
2. Is liked by many patients and healthcare providers, but not all groups can access it easily
3. Can work just as well as in-person care for some health issues
4. Needs more training for healthcare workers to manage the technology and remote consultations
The Department of Health and Human Services has made permanent changes to Medicare telehealth policies influenced by the pandemic. While many of these changes relate to mental health, it’s important to extend telehealth to other medical areas for Medicare recipients’ well-being.
That goes for maternity care, too. In May 2020, the American College of Obstetricians and Gynecologists urged lawmakers to adopt a three-pronged approach due to pandemic-related healthcare limits:
1. Make it easier to access telehealth and remote patient monitoring.
2. Increase coverage for necessary medical equipment.
3. Remove financial obstacles and fairness issues for patients.
The need to take action is urgent and persistent — and understanding that is the first step in forging long-term solutions to the problem of maternity care deserts.
