Access To Obstetric Services In Rural Counties Still Declining, With 9 Percent Losing Services, 2004-14
Access To Obstetric Services In Rural Counties Still Declining, With 9 Percent Losing Services, 2004-14
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DOI：
10.1377/hlthaff.2017.0338
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发表时间：
2017-09-01
期刊：
影响因子：
9.7
通讯作者：
Kozhimannil, Katy B.
中科院分区：
文献类型：
--
作者：
Hung, Peiyin;Henning-Smith, Carrie E.;Kozhimannil, Katy B.
最近农村产科单位和整个医院的关闭加剧了人们对生活在美国农村的2800多万育龄妇女获得护理的担忧。然而，最近产科单位关闭的程度尚未得到衡量。使用全国数据，我们发现，在2004- 2014年期间，9%的农村县失去了所有医院产科服务。此外，另有45%的美国农村县在研究期间根本没有医院产科服务。这使得超过一半的美国农村县没有医院产科服务。每个育龄妇女和人均产科医生和家庭医生较少的县;非西班牙裔黑人育龄妇女的比例较高;家庭收入中位数较低，以及对孕妇的医疗补助收入资格门槛限制更严格的州，缺乏医院产科服务的几率更高。同样类型的县也更有可能失去产科服务，这凸显了在脆弱和服务不足的农村社区提供足够的产科护理的挑战。
Recent closures of rural obstetric units and entire hospitals have exacerbated concerns about access to care for more than twenty-eight million women of reproductive age living in rural America. Yet the extent of recent obstetric unit closures has not yet been measured. Using national data, we found that 9 percent of rural counties experienced the loss of all hospital obstetric services in the period 2004-14. In addition, another 45 percent of rural US counties had no hospital obstetric services at all during the study period. That left more than half of all rural US counties without hospital obstetric services. Counties with fewer obstetricians and family physicians per women of reproductive age and per capita, respectively; a higher percentage of non-Hispanic black women of reproductive age; and lower median household incomes and those in states with more restrictive Medicaid income eligibility thresholds for pregnant women had higher odds of lacking hospital obstetric services. The same types of counties were also more likely to experience the loss of obstetric services, which highlights the challenge of providing adequate geographic access to obstetric care in vulnerable and underserved rural communities.