ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2025
Financial challenges of providing obstetric services at rural US hospitals.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Risk Factors for Loss of Hospital-Based Obstetric Care in Rural and Urban Hospitals.JAMA health forum · 2026Article
- Pharmacologic cervical ripening strategies and time-related outcomes: a community hospital cohort study.AJOG global reports · 2026Article
- Seasonality, Weather, and Obstetric Level of Care: An Analysis of Rural Delivery Locations.International journal of environmental research and public health · 2026Article
- Capacity Planning for Small Hospitals and Departments Illustrated Using Maternity and Paediatrics Departments: Roles for Weighted Population Density, Seasonality and Size, Myths Around Length of Stay and Factors Influencing Costs and Funding.International journal of environmental research and public health · 2026Article
- Bridging the Gap: A Mixed-Methods Evaluation of a New Rural Maternity Care Center Amid Nationwide Closures.International journal of environmental research and public health · 2026Article
- Financial challenges of providing obstetric services at rural US hospitals.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
purposeThis study describes perspectives of rural hospital administrators regarding the financial context for operating obstetric units, including the unique challenges they face and the strategies they have implemented to maintain obstetric services.
methodsIn this mixed-methods study, we used data from a survey we conducted from March to August 2021 of administrators of rural hospitals that had maintained or closed their obstetric units. Key financial outcomes included general finances, size and equipment, payor mix, workforce, and other fixed costs, examined descriptively. We also conducted thematic content analysis of open-ended responses to financial questions.
findingsRespondents from hospitals that closed obstetric services (n = 40) reported that physician shortages (67%), financial losses (62%), clinical safety (56%), liability insurance costs (51%), and nurse shortages (39%) influenced the decision to close obstetric units. Among hospitals with obstetrics (n = 88), more than half (55%) reported that their hospital was operating with a profit margin, but only 41% said their obstetric unit had more revenue than costs. Of the hospitals with obstetrics who responded about the future of their obstetric units, 77% (61/79) were confident that they would continue providing obstetric care in 10 years; their open-ended responses highlighted the importance of hospital leadership's commitment to maintaining obstetric services in their communities.
conclusionsRural hospitals cite clinical workforce challenges, high fixed costs, and declining birth volumes as financial challenges to providing obstetrics. Strategies for maintaining obstetric care in rural communities should account for lower birth volumes in rural facilities and these interrelated challenges.
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