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We KNOW they're closing because rural hospitals are no longer "econmically feasible" in a for-profit healthcare system. The point to debate is, as a society, is that what we want? Because when the consequenses of this really hit it will no longer be an abstraction, and it won't just hit the poor. They'll bear the brunt at first but it won't stop there. Do we want peope dead over profits or not? Do we try to find solutions or not? Or do we just let people die because they were "stupid" enough to live where they live?
No, we don't.
But I will say that this is a very complicated issue. It has very little to do with "wants".
For example, One issue driving a reduction in the quality of health care available in rural America is the availability of physicians.
The cost of educating a physician has skyrocketed in recent decades. Most physicians leave school and residency with huge debts. They can most easily pay these loans back by moving to a city and/or becoming a specialist. Specialist are in demand in cities.
If we want and adequate number of physicians and the array of expertise in rural America we will have to tackle this problem.
I will say this as a Republican, I don't think my party or any parties have really cared about rural area healthcare issues.
The repeal and replace effort in Congress totally avoids this issue, so we likely have to wait until the political hysteria passes, partisan politics calm down and a bi-partisan effort of rural Congressmen and Senators get together to find solutions.
Again, it depends on these politicians. It is a sad situation.
But I will say that this is a very complicated issue. It has very little to do with "wants".
For example, One issue driving a reduction in the quality of health care available in rural America is the availability of physicians.
The cost of educating a physician has skyrocketed in recent decades. Most physicians leave school and residency with huge debts. They can most easily pay these loans back by moving to a city and/or becoming a specialist. Specialist are in demand in cities.
If we want and adequate number of physicians and the array of expertise in rural America we will have to tackle this problem.
I will say this as a Republican, I don't think my party or any parties have really cared about rural area healthcare issues.
The repeal and replace effort in Congress totally avoids this issue, so we likely have to wait until the political hysteria passes, partisan politics calm down and a bi-partisan effort of rural Congressmen and Senators get together to find solutions.
Again, it depends on these politicians. It is a sad situation.
I agree with you. I don't think either side has really given this any attention.. and really rural areas in general (as well as small towns) have been getting the shaft for a long time on a lot of fronts.
I know at one point they had a program that gave newly graduated foregn born doctors some kind of extended Visa to practice in rural areas (?). I don't know if that went away. Maybe if they had a loan forgiveness program for doctors who agreed to practice in a rual area for X number of years? I know they do somethig similar for teachers/non profit workers. And maybe if there was some kind of program for facilities serving sparsely populated areas to purchase specific equipment with a government subsidy? I have no idea. If we want to keep the industry private there have to be ways we can step in for those areas where the profit model won't work.
One should not cry and complain that they must pay for gas to travel an additional 50 miles for OBGYN services.
The mom in the story was not quoted as complaining about gas money.
Quote:
Originally Posted by 2mares
I have an idea how these thing go when you live in a rural area, you have a risk delivery and your closest hospital dosen't have the facilities to deal with high risk cases. We know where the hospitals were located, we know where the patients were referred to.
No I cant verify, but three kids at 21, living with mom, no mention of a father. When they bring in complaints about gas money to travel to a hospital further away it invites a look into personal choices and responsibilities. Yes the hospital closing is an inconvenience but if one can not afford even gas money to go to the doctor should they be having additional children.
This mom was not complaining about gas money. The NYT article talked about women in the OB waiting room discussing the cost of gas to get to the new location.
You know, everyone is focused on the 21-year-old, but another woman in the article is a 36-year-old, married professional based in Kennett. She relates in the article that she was turned down by eight different obstetricians before finally finding one that could accept her as a patient in Jonesboro, Arkansas. Forget about the hospital for a minute, and think about that. She can't even get routine prenatal care short of a 108-mile commute. That's a tough situation.
Note: the information above is not specifically listed in the article, but it's easy enough to find using public resources.
Last edited by randomparent; 07-24-2018 at 04:11 PM..
It is relevant. If she had not gone into premature labor she most likely could have delivered at Poplar Bluff, she probably could have delivered there and then gone onto St. Frances. Something like this is not specific to twins, pregnancies/deliveries are considered high risk for many reasons. Twins may be "classified" high risk pregnancies but that generally means extra care and consideration and a potential for complications.
THE HOSPITAL CLOSED AFTER SHE GOT PREGNANT. She didn't plan to have to drive 2 hours away.
Again, stop being so focused on the woman's income and look at the overall point. What she had to travel for is not some super rare specialty service. Having twins or a high risk pregnancy is not unusual, and any decent natal facility should have what she needed. The nearest good one being 2 hours away is a problem that more and more people will have as this phenomenon gains steam... putting even rural babies born to parents who have good jobs and decent health insurance at risk.
You keep saying that there were hospitals 20 and 30 miles away... but they were bare bones at best and increasingly, those distances are going to get longer and longer for people in rural areas. At some point, people will start dying over this. What you are calling "not uncommon" WILL BECOME MORE AND MORE UNCOMMON. Your dstances will be the good old days.
We KNOW they're closing because rural hospitals are no longer "econmically feasible" in a for-profit healthcare system. The point to debate is, as a society, is that what we want? Because when the consequenses of this really hit it will no longer be an abstraction, and it won't just hit the poor. They'll bear the brunt at first but it won't stop there. Do we want peope dead over profits or not? Do we try to find solutions or not? Or do we just let people die because they were "stupid" enough to live where they live?
Here's where we part company. What do you call a "decent natal facility"? The rate of twins is about 3 in 100 births in the US. It takes a fairly large facility to have sufficient experience with twins. This mom probably should have been planning to go to a larger facility all along. Even the NYT seems to like these tear-jerker stories.
Rural hospitals have been closing for at least the past 50 years. The trend is probably going to continue. We are in need of some creative solutions for people who need immediate care, like heart attacks and childbirth. I'm surprised (and glad) she made it to the hospital in time to deliver there.
One thing I did find while doing a little research on this story is that St. Francis does have a transport helicopter outfitted for two neonatal patients, so if the young woman had been in real trouble, they'd hopefully have gotten to her.
I agree that the story is framed to raise concerns, but, you know, maybe we should be concerned about this. Prenatal care is really, really, really important for good outcomes, and that part of Missouri seems to be falling short of providing options.
Here's where we part company. What do you call a "decent natal facility"? The rate of twins is about 3 in 100 births in the US. It takes a fairly large facility to have sufficient experience with twins. This mom probably should have been planning to go to a larger facility all along. Even the NYT seems to like these tear-jerker stories.
Well it depends how you look at it. 3 in 100 is not uncommon to me. That means your typical facility- which will see at least a hundred births a year, usually much more - will have twins born there on a regular basis. Same with "at risk" births. There are a lot of older mothers now, or mothers with some underlying condition like diabetes or obesity. Any place that delivers babies will come across these circumstances multple times a year so to me, it's not unreasonable that a childbirth facility should be prepared.
I would consider rare something that only occured in like 1 in a thousand... where you could have hundereds of births a year and still not see it happen but once every other year, something like that. Twins and/or at risk births are not that IMO.
The problem right now is that the model is based on profit and not on what makes the best care serving the needs of a given population. It's not that twins are "rare", it's that there's not enough in rural areas to be profitable even though they will be born fairly regularly.
Well it depends how you look at it. 3 in 100 is not uncommon to me. That means your typical facility- which will see at least a hundred births a year, usually much more - will have twins born there on a regular basis. Same with "at risk" births. There are a lot of older mothers now, or mothers with some underlying condition like diabetes or obesity. Any place that delivers babies will come across these circumstances multple times a year so to me, it's not unreasonable that a childbirth facility should be prepared.
I would consider rare something that only occured in like 1 in a thousand... where you could have hundereds of births a year and still not see it happen but once every other year, something like that. Twins and/or at risk births are not that IMO.
The problem right now is that the model is based on profit and not on what makes the best care serving the needs of a given population. It's not that twins are "rare", it's that there's not enough in rural areas to be profitable even though they will be born fairly regularly.
I don't believe you work in health care, do you? I believe you are an educator. Yet you seem to know just how an OB unit should be run.
The closed hospital had an average of 500 births a year, according to the stats I found. That would mean ~15 twin births annually, on average. Obviously, it has to be an even number, so say 14 or 16. That is barely more than one set of twins a month! There's a big difference between "rare" (a term I did not use), once a month, and "frequent". Frequent would give the staff taking care of these patients, particularly the preemie babies, better skills. Sometimes it is better to travel some distance to make ensure the best results possible. Here are some stats on twins: https://www.verywellfamily.com/multi...t-data-2447119 If, of 16 twins born annually, about 9 will be low-birth weight. That is very few babies. Care always improves with more experience. Babies as little as the woman's in the OP need a Level III, maybe even Level IV nursery: https://rockymountainhospitalforchil...re-unit-levels
It doesn't really matter what you consider rare, again, a term I did not use.
The hospital that closed was a for-profit hospital. But it may surprise you to know that most hospitals in the US are either government (excluding the VA hospitals) or private non-profit. "According to the AHA, about 18 percent of U.S. hospitals are private, for-profit hospitals, while 23 percent are owned by state and local governments. The rest are private, nonprofit facilities." Did You Know: For-Profit Versus Nonprofit Hospitals | Health Net Broker Pulse
I think the discussion is being sidetracked by the young mother of twins. The part that didn't get much play in the article is the 36-year-old professional who could not find local prenatal care. She's driving 108 miles to Jonesboro for standard prenatal care. I don't know what the solution to that is, but I think it's concerning that the local OBs are so overwhelmed that not one of them was able to take on a new patient. We're not even talking about specialist care, just somebody to do the basics.
I think the discussion is being sidetracked by the young mother of twins. The part that didn't get much play in the article is the 36-year-old professional who could not find local prenatal care. She's driving 108 miles to Jonesboro for standard prenatal care. I don't know what the solution to that is, but I think it's concerning that the local OBs are so overwhelmed that not one of them was able to take on a new patient. We're not even talking about specialist care, just somebody to do the basics.
That sounds outrageous, but we don't really know all the details with that, either. It may not be a situation of the local OBs being so overwhelmed. It may be something else, like her insurance coverage, she wanted something special, some other issue. That's the problem with these articles.
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