Maternity ward closures' tradeoffs

One of the most documented trends is the closure of obstetrics departments. But counter to the conventional wisdom, some research shows that women may get better care after such closures.

• One paper published in Health Services Research earlier this year found that after an obstetric unit closure, the physicians relocated to a new hospital less than 20 miles away and used aggressive birth interventions — like C-sections — less often.
• "In the same way we shouldn't assume a service line shutting down is, on net, a bad thing, we also can't assume that we should throw resources to prop up every service line at every place. There may be opportunities to do something lower cost and better," said Michael Richards, an author of the paper and director of the Sloan Program in Health Administration at Cornell.

Other researchers have found consistent results.

• "Women have to travel further to the hospital, but it seems as though they are going to better-resourced hospitals that are higher quality," said Heather Royer, an economics professor at UC Santa Barbara.

Zoom in: The impact of closures on outcomes may be particularly noticeable in unusual cases, like breech delivery, Northwestern's Dranove said.

• "The outcome for both the birth mother and the child could be affected by the experience that the hospital and its physicians and nursing staff all have with that kind of specialized problem, in which case the closure might actually be a good thing because those patients will be redirected, usually, toward a center that has a lot more experience," he said.
• "So it's kind of like everybody travels more, but for a small percentage of the patients, it could have a dramatic impact on outcomes," he added.

The other side: A lot of closures happen in the context of hospital mergers, and what may end up happening is that patients get shifted to more lucrative sites of care, Dranove added.

• "Maybe what you're really doing is making sure those patients come to your more expensive urban hospital instead."

My thought bubble: Everything in health care is about tradeoffs and there seem to be absolutely zero easy answers to hard questions.