A 10-week-old baby drinks from a bottle. A recent study found that when rural hospitals were taken over by larger health systems, they were 30% less likely to still be offering labor and delivery services five years later. (Photo: John Moore/Getty Images)
Rural hospitals are less likely to offer maternity services after being taken over by a larger healthcare system, leading to mixed outcomes for mothers and babies. according to recent research.
This is part of an accelerating trend transformed how Americans get health care: Larger health care systems are swallowing up smaller facilities in the pursuit of financial stability.
“The hospital industry has undergone enormous transformation over the past few decades, with nearly 1,600 mergers occurring between 1998 and 2021,” said Martin Gaynor, study co-author and professor emeritus of economics and public policy at Carnegie Mellon, in his article statement.
He added that these large-scale changes to the health care system could impact health care costs, quality and access.
In the last five years over 100 rural hospitals stopped delivering babies or have announced they will stop doing so in 2025, according to the latest data from the Center for Health Care Quality and Payment Reform. Less than half of rural hospitals still offer labor and delivery services.
Gaynor and a team of researchers from Carnegie Mellon, Northwestern University and the University of Georgia examined how hospital mergers affected access to and quality of maternity care in rural areas. They found that rural hospitals were involved in more than 450 mergers between 2006 and 2019.
When these rural hospitals were acquired by larger systems, they were 30% less likely to still offer labor and delivery services five years later. Many closed maternity wards were the only local source of maternity care.
The researchers found that this loss translated into fewer resources – such as practicing OB-GYNs – in the county where the acquired hospital was located.
The number of births in these counties has not changed; families simply had to go elsewhere for care.
Researchers say less access to nearby health care may explain the miniature escalate in health problems among women during and after pregnancy and delivery in these counties, as well as the higher smoking rates among pregnant women.
On the other hand, we found that some patients went to more distant, higher quality facilities. In contrast, in rural hospitals that did not close maternity units after the merger, the quality of care tended to escalate.
In recent years, officials in dozens of states have advocated for legislation to escalate oversight of mergers and other health care transactions.
In awakening disastrous hospital closures due to corporate financial manipulationsome states have tightened their antitrust laws.
Only last year 22 states have passed at least 34 laws related to health care system consolidation and competition, according to the National Conference of State Legislatures, an advisory panel of lawmakers. Meanwhile, other states have done so paved the way health care mergers to save failing rural hospitals.
At least 35 states currently require hospitals, health systems, service providers and private equity firms to notify government officials of proposed mergers or other agreements.
Earlier this month, California lawmakers passed the regulation Bill expanding state power to oversee health care mergers and acquisitions. It goes to Democratic Gov. Gavin Newsom’s desk, though Newsom vetoed a similar solution last year.
At the federal level, President Donald Trump’s administration has not signaled interest in increasing antitrust oversight. But Trump’s recent tax and spending bill included $50 billion in funding over the next decade to support states strengthen health care in rural areas. Huge cuts to Medicaid in law as well can have devastating consequences however, on rural hospitals that are struggling to stay on the market.
This week, the Centers for Medicare and Medicaid Services announced that states have until November 5 to apply for funding for rural health care. States must show that they will employ federal dollars in a manner consistent with CMS’ stated goals, including helping to improve access to care and strengthening health care worker retention.
Stateline reporter Anna Claire Vollers can be reached at: avollers@stateline.org.
This story was originally produced by Statisticswhich is part of States Newsroom, a nonprofit news network that includes Pennsylvania Capital-Star, and is supported by grants and a coalition of donors as a 501c(3) public charity.
