Impact of maternity unit closures on access to obstetrical care: The French experience between 1998 and 2003

Pilkington, Hugo; Blondel, Béatrice; Carayol, Marion; Breart, Gérard; Zeitlin, Jennifer

doi:10.1016/j.socscimed.2008.07.021

Cited by 43 publications

(42 citation statements)

References 33 publications

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“…The increased number of volume surges reported by our informants parallels similar surges in other areas, such as those caused by emergency department closures in Los Angeles, 22 urban hospital closures, 23 and the routine operation of obstetric units 24 and provision of pediatric hospital care. 25 Similar concerns have been raised when public health departments and hospitals discuss the potential for mass-casualty care.…”

Section: Discussionsupporting

confidence: 71%

Lessons For Providers And Hospitals From Philadelphia’s Obstetric Services Closures And Consolidations, 1997–2012

et al. 2014

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The Affordable Care Act is triggering an increase in hospital consolidation and mergers. How other hospitals respond to these disruptions in supply could influence patient outcomes. We examined the experience of Philadelphia County, Pennsylvania (coterminous with the city of Philadelphia), where thirteen of nineteen hospital obstetric units closed between 1997 and 2012. Between October 2011 and January 2012 we interviewed twenty-three key informants from eleven hospitals (six urban and five suburban) whose obstetric units remained open, to understand how the large number of closures affected their operations. Informants reported having confronted numerous challenges as a result of the obstetric unit closures, including sharp surges in delivery volume and an increase in the proportion of patients with public insurance or no insurance. Informants reported adopting a number of strategies, such as innovative staffing models, to cope with the added demand brought about by the closure of nearby obstetric units. Informants emphasized that interhospital communication could mitigate closures' stresses on the health care system. Our study supports the need for policy makers to anticipate reductions in supply and monitor patient outcomes.

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Section: Discussionsupporting

confidence: 71%

Lessons For Providers And Hospitals From Philadelphia’s Obstetric Services Closures And Consolidations, 1997–2012

et al. 2014

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“…Their study postulated various reasons why this may be the case but more research is needed to examine the changing role of geographical factors in influencing utilisation patterns over time. Similar techniques may also be applied to investigate the impacts on utilisation patterns of openings (and closures) of health services (French et al 2008), or changes in public transport provision, on utilisation patterns and GIS has recently been used, for example, in an investigation of the impacts of maternity unit closures on access to obstetrical care in France in terms of the increase in mean minimum straight-line distance (Pilkington et al 2008). In their study, based on a sample of births in 1998 and 2003, the researchers did not find a significant increase in self reported travel times between the commune of residence of the mother and the commune in which the maternity units were located following such closures.…”

Section: Discussionmentioning

confidence: 99%

The role of GIS for health utilization studies: literature review

Higgs

2009

Health Serv Outcomes Res Method

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There have been a plethora of studies investigating access issues in relation to health services but until recently a relative lack of research on geographical factors that may be influencing utilisation patterns. This paper includes a timely review on what is known from existing studies, a description of the main methodological concerns highlighted by such studies and draws on the review to present some ideas for more research in this area. The use of Geographical Information Systems (GIS) in investigating the relative importance of geographical factors on utilisation patterns is advocated through a review of published studies and a call made for more research to examine potential relationships with for example health outcomes. Recent advances with regard to the availability of detailed geographically disaggregate data and new location-based techniques such as developments in Global Positioning Systems (GPS) hold out great promise in such regards. Finally the policy relevance of such studies is re-iterated in terms of helping to tackle perceived inequities in the system, addressing health inequalities as well as gauging the effectiveness of current and planned service configurations.

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“…Cette évolution répond à des contraintes du point de vue de la rentabilité économique des établissements et de la démographie médicale, elle facilite l'organisation des gardes et répond à une demande de sécu-rité plus grande. Selon les femmes, cette évolution n'a pas entraîné une dégradation de l'accessibilité géographique des maternités, en termes de temps de transport pour aller à la maternité [4,31]. Cependant, dans les zones très reculées, le risque d'accoucher hors maternité est élevé, si les femmes doivent parcourir plus de 30 km pour atteindre la maternité la plus proche [32].…”

Section: Lieu D'accouchementunclassified

La santé périnatale en France métropolitaine de 1995 à 2010. Résultats des enquêtes nationales périnatales

Blondel

Lelong

Kermarrec

et al. 2012

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

138

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Impact of maternity unit closures on access to obstetrical care: The French experience between 1998 and 2003

Cited by 43 publications

References 33 publications

Lessons For Providers And Hospitals From Philadelphia’s Obstetric Services Closures And Consolidations, 1997–2012

Lessons For Providers And Hospitals From Philadelphia’s Obstetric Services Closures And Consolidations, 1997–2012

The role of GIS for health utilization studies: literature review

La santé périnatale en France métropolitaine de 1995 à 2010. Résultats des enquêtes nationales périnatales

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