Expecting Harm? The Impact of Rural Hospital Acquisitions on Maternal Health Care

Abstract

While there is extensive research documenting the effects of hospital acquisitions on cost and quality, impacts on access to care have received less attention. Acquirers may limit access by closing an acquired hospital or eliminating individual service lines. However, acquirers may have more resources to improve care delivery. We study the impact of hospital acquisitions on obstetric care in rural markets, where there may be heightened concern about the availability of local care options. We find that acquired rural hospitals are substantially more likely to close obstetric units, with resulting large reductions in the number of births at the hospital. We find suggestive evidence of spillovers to general maternal health care resources and delayed prenatal care in the affected communities, but little evidence of effects on health outcomes. We find decreases in maternal transfers and increases in procedures consistent with women shifting to delivering in better resourced hospitals.