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Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the US

Author

Listed:
  • Stefanie J. Fischer
  • Heather Royer
  • Corey D. White

Abstract

Over the last few decades, health care services in the United States have become more geographically centralized. We study how the loss of hospital-based obstetric units in over 400 counties affect maternal and infant health via a difference-in-differences design. We find that closures lead mothers to experience a significant change in birth procedures such as inductions and C-sections. In contrast to concerns voiced in the public discourse, the effects on a range of maternal and infant health outcomes are negligible or slightly beneficial. While women travel farther to receive care, closures induce women to receive higher quality care.

Suggested Citation

  • Stefanie J. Fischer & Heather Royer & Corey D. White, 2022. "Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the US," NBER Working Papers 30141, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:30141
    Note: CH EH
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    Cited by:

    1. Alex Hollingsworth & Krzysztof Karbownik & Melissa A. Thomasson & Anthony Wray, 2024. "The Gift of a Lifetime: The Hospital, Modern Medicine, and Mortality," American Economic Review, American Economic Association, vol. 114(7), pages 2201-2238, July.
    2. Molitor, David & White, Corey, 2024. "Do cities mitigate or exacerbate environmental damages to health?," Regional Science and Urban Economics, Elsevier, vol. 107(C).
    3. Dingel, Jonathan & Gottlieb, Joshua & Lozinski, Maya & Mourot, Pauline, 2023. "Market Size and Trade in Medical Services," CEPR Discussion Papers 18029, C.E.P.R. Discussion Papers.
    4. Pinka Chatterji & Chun-Yu Ho & Xue Wu, 2023. "Obstetric Unit Closures and Racial/Ethnic Disparity in Health," NBER Working Papers 30986, National Bureau of Economic Research, Inc.
    5. Freedman, Seth & Hoehn-Velasco, Lauren & Jolles, Diana R., 2025. "Intensive care supply and admission decisions," Journal of Health Economics, Elsevier, vol. 100(C).
    6. Bilge Erten & Yunus Cem Yılmaz, 2025. "Hospital supply and infant mortality: Evidence from Islamic political representation in Turkey," Journal of Population Economics, Springer;European Society for Population Economics, vol. 38(1), pages 1-26, March.
    7. Petek, Nathan, 2022. "The marginal benefit of hospitals: Evidence from the effect of entry and exit on utilization and mortality rates," Journal of Health Economics, Elsevier, vol. 86(C).

    More about this item

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • J08 - Labor and Demographic Economics - - General - - - Labor Economics Policies
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • J18 - Labor and Demographic Economics - - Demographic Economics - - - Public Policy

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