Does closing hospitals and maternity wards mean worse care for Philly’s poorest families?

Last year, Hahnemann Hospital, a safety net hospital in downtown Philadelphia, announced it was bankrupt, and shuttered its doors after nearly 200 years. Most of its patients were on Medicare and Medicaid, and leaders both local and national, including then-presidential candidate Bernie Sanders, criticized the decision to put profits over the needs of struggling patients. Hundreds of medical residents scrambled to find jobs.

Among the patients affected were more than 800 pregnant people who had to find another place to have their babies. A nurse described hospitals in Philadelphia "bursting at the seams" with pregnant people, including those at high risk.

From 1997 to 2012, 13 out of 19 hospital maternity units in the city of Philadelphia shut down. The remaining maternity units had to deal with a 58 percent increase in volume, leading to overcrowding, understaffing, and poor morale.

Philadelphia and the country as a whole have long been struggling to make progress in improving the health of mothers and newborns. Do these shutdowns lead to worse care?

A previous analysis found that infant mortality rates rose by nearly 50% after a series of hospitals closed obstetric units in 1997, but those mortality rates leveled off by 2007. Still, one maternal and fetal medicine specialist told us that just as Hahnemann was about to close, obstetrics leaders across the city made a plan to take in the patients left without a specialist so no one would be left without care.

Some even argue that closing maternity wards and consolidating existing services leads to better coordination, more efficient care and better outcomes.

Since 2007, when that last analysis ended, five more hospitals in Philadelphia have closed. More want to merge: Thomas Jefferson University wants to buy the struggling Einstein Healthcare Network, in a case that the federal government is seeking to block on antitrust grounds. Tower Health, another hospital operator in the Philadelphia area, is considering selling its six hospitals due to mounting debt and huge losses over the past two years. Since Philadelphia General Hospital closed in 1977, Philadelphia has been left with no public hospital.

The pandemic is adding financial pressures to many health systems. As Philadelphia peers into a future with more consolidation and closures, we want to know if closing hospitals and maternity wards actually leads to worse care for Philadelphia’s moms and babies.

To find out, our 2020 Data Fellowship project will compare infant and maternal mortality rates before and after obstetrics units closed, using neighboring, comparable counties that did not experience a similar loss of obstetric units as a control. A previous study used this methodology for 1995 to 2005, but as more hospitals close, and the pressure to consolidate hospitals and health systems continues, it is worthwhile to look at how the rest of the timeline has played out.

This is especially timely as hospitals lost even more money when the pandemic forced them to cancel elective surgeries. Lucrative procedures such like hip or knee replacements effectively subsidize less profitable operations, like labor and delivery. Labor and delivery units are one of the least profitable departments because of low reimbursement for maternity care, and high medical malpractice premiums. That’s part of why these units are the first to go when hospitals want to cut costs.

The mortality rate data would get us started on the question of how quality of care changed after obstetrics units closed. In turn, those numbers can guide our interviews. We’ll talk with people who had their babies at the hospitals that closed, midwives, medical residents, doctors, nurses, and other staff who can tell us what those hospitals meant to them, what it was like there, and what happened around the time of the hospitals closing. Data gives us the larger context; personal experiences allow us to zoom in, illustrate those trends, and gain some insight on what it was like to be a patient or a worker at those hospitals.

Our story also helps us look forward: How did hospital leaders plan for those obstetrics units closing? What worked and what didn't work? Can these experiences serve as useful guides as local governments and health authorities in Philadelphia and possibly the rest of the country, plan for a post-pandemic future with fewer health care institutions?