Access to maternity care in rural Washington: its effect on neonatal outcomes and resource use

• Published in: American journal of public health (1971) Vol. 87; no. 1; pp. 85 - 90
• Main Authors: Nesbitt, T S, Larson, E H, Rosenblatt, R A, Hart, L G
• Format: Journal Article
• Language: English
• Published: Washington, DC Am Public Health Assoc 01.01.1997; American Public Health Association
• Subjects: Access; Adolescent; Adult; Babies; Biological and medical sciences; Birth certificates; Birth weight; Births; Cesarean section; Childbirth; Codes; Factors; Female; General aspects; Gestational age; Health and social institutions; Health care access; Health care expenditures; Health Resources - statistics & numerical data; Health Services Accessibility; Health Services Research; Hospital Charges; Hospitalization; Humans; Insurance, Health; Length of Stay; Maternal child nursing; Maternal health care; Maternal Health Services - organization & administration; Medicaid; Medical sciences; Newborn babies; Obstetrics; Outcomes; Physicians; Population; Pregnancy; Pregnancy Outcome; Prenatal care; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Rural areas; Rural Health Services - organization & administration; United States; Washington; Washington State; Womens health; United States; North America; America; Human; Health system; Prognosis; Accessibility; Obstetrics; Care; Pregnancy; Newborn; Hospital ward; Rural area; Delivery; Woman; Public health
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.87.1.85

This study sought to ascertain the effects of poor local access to obstetric care on the risks of having a neonate diagnosed as non-normal, a long hospital stay, and/or high hospital charges. Washington State birth certificates linked with hospital discharge abstracts of mothers and neonates were used to study 29809 births to residents of rural areas. Births to women from rural areas where more than two thirds of the women left for care were compared with births to women from rural areas where fewer than one third left for care. Poor local access to providers of obstetric care was associated with a significantly greater risk of having a non-normal neonate for both Medicaid and privately insured patients. However, poor local access to care was consistently associated with higher charges and increased hospital length of stay only if the patient was privately insured. These results indicate that local maternity services may help prevent non-normal births to rural women and, among privately insured women, might decrease use of neonatal resources.