Healthcare Deserts still Exist

[daisylu]

I would hate to have to jump through hoops like this woman about to give birth. Being expected to drive more than hour when in labor, and in another state? Article does not mention health insurance, but from my own experience, I had to jump through so many hoops to get the bills paid when I delivered in a state that I did not reside in - though I worked less than 10 minutes from that hospital. And that was 25 years ago last month!

Mom-to-be Stephanie Zuroski hopes she recognizes the signs of labor quickly, because the hospital where she plans to deliver her first child is more than an hour from her home in rural Elk County, Pennsylvania.



Elk County is about 2½ hours outside Pittsburgh, nestled at the edge of the Allegheny National Forest. Zuroski grew up on a farm and is familiar with the tradeoffs that come with rural living.



“I am accustomed to driving to get the things that I need,” said Zuroski, 32.



What she didn’t expect was the lack of labor and delivery units in the county, which means she’ll have to drive out-of-state to give birth in a hospital.



“When I started looking into pregnancy and [obstetrician] care, I was shocked local hospitals weren’t delivering babies,” Zuroski said.



In February, the Penn Highlands Healthcare hospital system announced that it was “realigning services” and moving labor and delivery services from Penn Highlands Elk — the only hospital in the county — to its sister hospital Penn Highlands DuBois, about 30 miles south in Clearfield County, on May 1. The shift limits maternal health care options in the area, and could raise the risk of people delivering in riskier conditions — even at home or in their cars.






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[swamp]

Yup.  Welcome to life in a rural world. 

Although there is a hospital in my town, the services are slowly dwindling.  

[pulmonarymd]

Expect it to get worse

[busymom]

Sadly, it isn't just happening out in the sticks.  The closest hospital to us stopped delivering babies.  I'm not sure what they'd do if someone came to the ER in labor.


Now, the next-closest hospital, while they are still delivering babies, won't be taking care of NICU babies.  I don't know what's going on, but it's getting ugly.  And we're in the 'burbs.  

[pulmonarymd]

It's all economics. It requires a certain number of staff, specialized equipment, medications, insurance, etc, to provide these services. You need to staff them for deliveries, even if none happen. You only get paid if you have one. If there are not enough deliveries to make it profitable, they stop providing that "service line". Add in consolidation, mergers, and bankruptcies, economics of scale, and the number of 2 physician couples, and smaller hospitals/areas are less enticing. Physicians vote with their feet, leaving no one to cover. Pile on stupid laws, and you have our current situation

[daisylu]

Apr 30, 2024 13:29:07 GMT -5 pulmonarymd said:

Expect it to get worse

I do not want to like this, but I see what you are saying.

[pulmonarymd]

Hospital finances, especially smaller, rural hospitals, is not good. Salaries for nurses and other staff rose significantly with COVID, and have not gone back down, since a number of people left the field, and reimbursement from both Medicare and private insurance have not increased enough to match it. I think about 20% of rural hospitals are at risk of bankruptcy, and the number is substantially higher in states that have not expanded Medicaid. But we have the greatest healthcare system in the world, right?

[plugginaway22]

My son and DIL just had a baby and the hospital was an hour drive from where they live. Also Pediatrician. People with true medical emergencies get airlifted from the closer small town urgent care. I will say that this is in the western states and seems normal to people there. I grew up in populated east coast areas where there are plenty of hospitals to choose from.

[Knee Deep in Water Chloe]

I guess that's just normal where I live?

[Spellbound454]

So what are you supposed to do if the baby becomes distressed?

It could be dead by the time you got to hospital.

How would you even know it was in distress unless you had a monitor trace.


Childbirth is a dangerous business for mother and child.

and if its a question of money surely, there will be more litigation if there is an increase babies are getting injured.

[The Walk of the Penguin Mich]

Here are definitely healthcare deserts out there, but living far enough away that it is 2.5 hours away is a choice as well.  

Logically, why would someone expect a fully stocked childbirth unit for an extremely low population?  Financially, it simply doesn’t make sense……regardless of how you spin it.  If you are making the choice to live that rurally, then it might make sense to have a Plan B should you become pregnant.  

While we do not live in such a desert, healthcare where I live generally is less than good.  My experience with this demonstrated it 13 years ago, and events recently with friends have just verified what I was fairly sure of.  We know probably in the next 10 years, we are going to have to move to where there is more viable healthcare.  If TD and I were less healthy, then that might be sooner.  As idyllic a place where we live currently, access to good healthcare is ultimately going to have to trump this.

[teen persuasion]

May 5, 2024 14:54:35 GMT -5 The Walk of the Penguin Mich said:

Here are definitely healthcare deserts out there, but living far enough away that it is 2.5 hours away is a choice as well.  

Logically, why would someone expect a fully stocked childbirth unit for an extremely low population?  Financially, it simply doesn’t make sense……regardless of how you spin it.  If you are making the choice to live that rurally, then it might make sense to have a Plan B should you become pregnant.  

While we do not live in such a desert, healthcare where I live generally is less than good.  My experience with this demonstrated it 13 years ago, and events recently with friends have just verified what I was fairly sure of.  We know probably in the next 10 years, we are going to have to move to where there is more viable healthcare.  If TD and I were less healthy, then that might be sooner.  As idyllic a place where we live currently, access to good healthcare is ultimately going to have to trump this.

It’s not a choice if they close all the hospitals that used to exist.

I has a whole long post the got eaten, but essentially my region HAD hospitals that have all been gradually downgraded, merged, downgraded again, bought out, some closed, some replaced with essentially glorified ERs, not full hospitals. My county seat’s hospital is a new standalone ER only, now. Last true hospital in the county is slated for same rebuild/close old treatment next! Two adjacent counties have no or minimal hospitals ( and on far sides from last hospital which is against water and an international border). Two of my kids were born in a now minimal hospital less than 10 miles from us over the county line. Last baby I had no option but city hospital in metro area in county an hour south of us - as it was blizzard season and a storm predicted at the expected date, I was induced early to avoid going into labor and having to drive into a snow band. Ironically at the same hospital I walked to in labor with my first, when we lived in that city.

But that city is rapidly consolidating most of its hospitals downtown on a medical corridor - children’s, cancer center, general hospital, medical school . Again on the waterfront and international border. Dumbest plan ever - I’m waiting for an emergency to make nearly all the region's hospitals inaccessible simultaneously. Redundancy is good - spread the remaining facilities around the region, please for easier access and to avoid trouble microclimates like the snow belt.

[djAdvocate]

Apr 30, 2024 14:15:20 GMT -5 pulmonarymd said:

Hospital finances, especially smaller, rural hospitals, is not good. Salaries for nurses and other staff rose significantly with COVID, and have not gone back down, since a number of people left the field, and reimbursement from both Medicare and private insurance have not increased enough to match it. I think about 20% of rural hospitals are at risk of bankruptcy, and the number is substantially higher in states that have not expanded Medicaid. But we have the greatest healthcare system in the world, right?

if we had a robust public healthcare system, of course, these problems would mostly disappear.

i know.  socialism.  right.

[djAdvocate]

May 4, 2024 4:12:37 GMT -5 Spellbound454 said:

So what are you supposed to do if the baby becomes distressed?

It could be dead by the time you got to hospital.

How would you even know it was in distress unless you had a monitor trace.


Childbirth is a dangerous business for mother and child.

and if its a question of money surely, there will be more litigation if there is an increase babies are getting injured.

better prenatal care would be helpful.  but there is a reason that about half of the public doesn't do ANY in the US.  it is because of the COST.

in other words, we put our kids at risk because we can't afford not to.

i mean, this stuff is not mysterious, Spellbound.

[haapai]

May 11, 2024 13:53:01 GMT -5 djAdvocate said:

May 4, 2024 4:12:37 GMT -5 Spellbound454 said:

So what are you supposed to do if the baby becomes distressed?

It could be dead by the time you got to hospital.

How would you even know it was in distress unless you had a monitor trace.


Childbirth is a dangerous business for mother and child.

and if its a question of money surely, there will be more litigation if there is an increase babies are getting injured.

better prenatal care would be helpful.  but there is a reason that about half of the public doesn't do ANY in the US.  it is because of the COST.

in other words, we put our kids at risk because we can't afford not to.

i mean, this stuff is not mysterious, Spellbound.

Hey DJ, don't be rude to Brits who are gobsmacked by how Yanks do healthcare!  I want to give you props for describing how cynical and cruel things are here but nothing gets learned when you are rude. 

[djAdvocate]

May 11, 2024 14:18:33 GMT -5 haapai said:

May 11, 2024 13:53:01 GMT -5 djAdvocate said:

better prenatal care would be helpful.  but there is a reason that about half of the public doesn't do ANY in the US.  it is because of the COST.

in other words, we put our kids at risk because we can't afford not to.

i mean, this stuff is not mysterious, Spellbound.

Hey DJ, don't be rude to Brits who are gobsmacked by how Yanks do healthcare!  I want to give you props for describing how cynical and cruel things are here but nothing gets learned when you are rude. 

GOD, i love this board.  

[cronewitch]

My grandparents lived in a tiny town when my mom was born. Grandma went to the small town and stayed with her sister to wait for the baby. Mom was born at her aunt's house, her aunt was a midwife. It was 1926 so they weren't licensed or anything they just delivered the babies. When I lived in the small town in the 70s I worked at the hospital. They delivered babies. Once we had 7 patents so I got laid off so they could give more hours to other people. Any major medical was airlifted to the city so they mostly did tonsils or other minor things. 

[Spellbound454]

May 11, 2024 16:33:32 GMT -5 djAdvocate said:

May 11, 2024 14:18:33 GMT -5 haapai said:

Hey DJ, don't be rude to Brits who are gobsmacked by how Yanks do healthcare!  I want to give you props for describing how cynical and cruel things are here but nothing gets learned when you are rude. 

GOD, i love this board.  

You are right, it is a mystery to me how you can not have healthcare.

Having said that we have a smaller Country, whereas your wide open spaces are really wide and open

Think I would be tempted to move to a rental nearby the hospital immediately prior to birth.

[busymom]

May 12, 2024 3:54:22 GMT -5 cronewitch said:

My grandparents lived in a tiny town when my mom was born. Grandma went to the small town and stayed with her sister to wait for the baby. Mom was born at her aunt's house, her aunt was a midwife. It was 1926 so they weren't licensed or anything they just delivered the babies. When I lived in the small town in the 70s I worked at the hospital. They delivered babies. Once we had 7 patents so I got laid off so they could give more hours to other people. Any major medical was airlifted to the city so they mostly did tonsils or other minor things. 

     My grandmother used to deliver babies for the farm families in her community.  This was back around 1910-1920's.  It's not that there wasn't a hospital in the community, it's just people couldn't afford a doctor.  She didn't have any formal training, but she had a great track record.  One of her children, my aunt, went to nursing school, and ended up working at a hospital and worked with newly delivered babies too.  

[djAdvocate]

May 14, 2024 13:26:01 GMT -5 Spellbound454 said:

May 11, 2024 16:33:32 GMT -5 djAdvocate said:

GOD, i love this board.  

You are right, it is a mystery to me how you can not have healthcare.

Having said that we have a smaller Country, whereas your wide open spaces are really wide and open

Think I would be tempted to move to a rental nearby the hospital immediately prior to birth.

it is a symptom of a larger problem here.  i would like to live somewhere that did not have that larger problem.

[haapai]

To be honest, I'm not really sure what "larger problem" DJ is referring to.  It could be many things.  I'd like to think that he is referring to my nation's love enduring love affair with inequality but I'm not entirely sure about that. 

[djAdvocate]

May 15, 2024 11:52:53 GMT -5 haapai said:

To be honest, I'm not really sure what "larger problem" DJ is referring to.  It could be many things.  I'd like to think that he is referring to my nation's love enduring love affair with inequality but I'm not entirely sure about that. 

it was brought up on the gun thread.  lack of social cohesion.  lack of empathy.  disrespect for government.

we have a hermit and tribal mentality.  it works against pretty much everyone, except the uber wealthy.

[teen persuasion]

May 14, 2024 17:36:30 GMT -5 busymom said:

May 12, 2024 3:54:22 GMT -5 cronewitch said:

My grandparents lived in a tiny town when my mom was born. Grandma went to the small town and stayed with her sister to wait for the baby. Mom was born at her aunt's house, her aunt was a midwife. It was 1926 so they weren't licensed or anything they just delivered the babies. When I lived in the small town in the 70s I worked at the hospital. They delivered babies. Once we had 7 patents so I got laid off so they could give more hours to other people. Any major medical was airlifted to the city so they mostly did tonsils or other minor things. 

     My grandmother used to deliver babies for the farm families in her community.  This was back around 1910-1920's.  It's not that there wasn't a hospital in the community, it's just people couldn't afford a doctor.  She didn't have any formal training, but she had a great track record.  One of her children, my aunt, went to nursing school, and ended up working at a hospital and worked with newly delivered babies too.  

I was talking with DD1 last night about classmates she's kept up with on FB, and it trended to who has kids and how many. DD1 is expecting #3 imminently, and most of the others averaged 3 or so except for a few who were a bit younger (so may catch up). We also attended toddler story time at the library on base (DD1 is military), and I was jealous there were so many young moms attending (story time is nearly dead in my community).

It occurred to me later that the military parents had no worries about healthcare, as Tricare  takes care of everything. And her other mom friends with many kids were high paid professionals in tech or similar, so also had fewer healthcare issues.

So for all the Republican handwringing about "nobody's having babies", they've focused on the wrong way to get more young people to choose to have kids. Provide universal healthcare, and decent income support for families, and they'd see a baby boom like I have seen on base here.

[busymom]

May 15, 2024 13:03:06 GMT -5 djAdvocate said:

May 15, 2024 11:52:53 GMT -5 haapai said:

To be honest, I'm not really sure what "larger problem" DJ is referring to.  It could be many things.  I'd like to think that he is referring to my nation's love enduring love affair with inequality but I'm not entirely sure about that. 

it was brought up on the gun thread.  lack of social cohesion.  lack of empathy.  disrespect for government.

we have a hermit and tribal mentality.  it works against pretty much everyone, except the uber wealthy.

    You just described my personal experience in FL very well.  I was born & raised in the Midwest, where, for example, if your car breaks down people will still stop & help.  Or, if you see a toddler running loose by itself, generally someone will make sure that baby gets back to mama or dad.  In Florida, at least in my former community, if your car breaks down, have a nice wait, because folks just don't stop to even ask if you're ok.  Many times DH & I joked that we felt like we were living in a different country.  And, don't get me started on their healthcare system, or lack of one.  

   We seriously need to get back to the days when folks helped their neighbors more.  I got REALLY tired of the "better them than me" attitude.  Very surprising, since I was told we were still living in the Bible Belt.  Maybe people should actually read & follow the example of the Good Book.  

[djAdvocate]

during the space race, we had common cause.

we need something like the space race to bind us together. environmental issues would seem like an obvious choice.

[teen persuasion]

May 16, 2024 1:11:51 GMT -5 djAdvocate said:

during the space race, we had common cause.

we need something like the space race to bind us together. environmental issues would seem like an obvious choice.

You would think, but the denial runs deep.

[Cheesy FL-Vol]

May 16, 2024 1:11:51 GMT -5 djAdvocate said:

during the space race, we had common cause.

we need something like the space race to bind us together. environmental issues would seem like an obvious choice.

One would think Covid would have been a common cause issue.