The Cost of Maternity Care in Rural Hospitals

FEDERAL health planners, in the first draft of proposed national guidelines for health planning, observed: Facilities not located in SMSAs [Standard Metropolitan Service Areas] of over 100,000 population should provide at least 500 deliveries annually.... Below 500 deliveries, the quality of care and efficiency are decreased significantly.¹ This opinion should be critically examined because it is likely to influence the availability of health care, especially in rural areas. Iowa, for example, with a population of 2.8 million people, has 129 hospitals that provide maternity care; of these, 105 (81%) had fewer than 500 deliveries in 1977. Methods A questionnaire designed by us was sent to administrators of Iowa hospitals with maternity services. Figure 1 shows the items assessed on the questionnaire. One hundred twenty-eight questionnaires were sent (the tertiary center at the University of Iowa was not included), and 103 responses were obtained (80% ). Four of the hospitals responded