Improving Health Care Access for Rural Women

The challenge of accessing health care for rural women in North Carolina presents a striking contradiction: small, isolated hospitals struggle to maintain essential services, such as childbirth and OB/GYN care, yet their communities are unable to cope with the loss of these services.

To halt or ideally reverse this alarming trend, there is a crucial need for greater accountability, stronger incentives, and enhanced support for rural hospitals and health care professionals. A robust regulatory and legislative framework, established and sustained by North Carolina’s legislature and the Department of Health and Human Services, could be instrumental in realizing this goal.

While the proposed reforms would represent a significant shift for North Carolina, similar initiatives aimed at improving rural women’s health services are being introduced or considered in various other states.

This article is the concluding part of a three-part investigative series by Carolina Public Press that scrutinizes the crisis surrounding rural women’s access to healthcare in North Carolina. Previous installments examined state data outlining maternal care deserts and the underlying causes of hospital unit closures and service cutbacks.

Addressing Standards of Care for Rural Women’s Health

In North Carolina, the state enforces specific neonatal levels of care, meaning that hospitals must adhere to designated standards in caring for infants. If a hospital that commits to providing level IV care— the highest standard—drops to level III, the Division of Health Service Regulation intervenes.

However, there is no equivalent system for maternal care in North Carolina. In contrast, 16 other states have implemented standards governing maternal care levels provided by hospitals, including Tennessee, Georgia, and South Carolina.

For instance, Mississippi, which faces severe challenges with maternal and infant mortality, is developing a systematic approach to establish standards for both maternal and infant care, with plans to launch this initiative later this year.

Enhancing Data Collection and Accountability

Currently, the Department of Health and Human Services (DHHS) lacks rigorous or standardized data collection for maternal care across hospitals. Implementing a more comprehensive data collection system would enable the agency to identify and tackle prevailing issues, and this would require legislative action to mandate such oversight.

State Representative Julie von Haefen emphasized the importance of enhanced data collection as a foundational step in addressing the crisis: “(DHHS) needs to have more data. If we don’t know what’s happening, how can we figure out how to solve it? Increased data collection will help us pinpoint where to direct our efforts.”

Furthermore, county health departments currently lack the authority to hold hospitals accountable, even though these departments collaborate with local hospitals to create Community Needs Health Assessments. Empowering these departments with regulatory authority could prevent the reduction or elimination of health services for rural women.

Financial Strategies to Support Rural Women’s Services

Maternity services typically operate at a financial loss, which complicates their sustainability. In rural areas where a majority of patients rely on Medicaid, maternity care becomes even less profitable for hospitals. Proposed cuts to Medicaid could exacerbate this already precarious situation.

Ami Goldstein, a certified nurse-midwife, pointed out, “Maternity units often are loss leaders. Even with a few births a month, hospitals must keep staff on hand.” Lower birth volumes lead to elevated per-patient costs, rendering many rural services economically unfeasible.

To address this issue, increasing Medicaid reimbursement rates for rural hospitals and practitioners could be a viable solution. State Rep. Timothy Reeder has taken up the cause for these enhanced reimbursements, while the future of Medicaid funding on a national level remains uncertain.

Workforce Development for Healthcare in Rural Areas

The decline in the rural health workforce presents a critical challenge. Creating incentives for specialists to work in rural hospitals is vital. Training graduates and aspiring healthcare professionals to serve in rural settings is equally paramount.

Rep. Reeder highlighted, “Providing care close to home is ideal. It is crucial to support rural hospitals and practitioners.” He noted initiatives to fund rural residencies, provide loan repayment assistance for various health professions, and expand training programs through community colleges as steps toward resolving workforce shortages.

Rep. von Haefen also advocates for innovative solutions to attract healthcare professionals back to rural areas, suggesting a “Grow Your Own” program to encourage newly trained nurses and doctors to return to practice in their hometowns.

Furthermore, developing existing practitioners by enabling family doctors and emergency medical technicians to broaden their scope of practice, along with continuous training, can enhance healthcare delivery in underserved areas. Rep. Allen Buansi expressed the importance of local doctors being well-trained in sufficient prenatal, delivery, and postnatal care, proposing state funding to support such training initiatives.

As North Carolina’s rural communities face the potential loss of remaining women’s health services, proactive regulatory adjustments and incentive models can help ensure the survival of vital maternity care. By fostering financial reforms, targeted workforce development initiatives, and improved accountability, North Carolina could revitalize access to crucial health services, saving the lives of women and children throughout the state.

The state has the potential to restore rural women’s health programs that hospitals have diminished, and if these regulatory and incentive structures are implemented, a brighter future for healthcare in rural North Carolina could emerge.

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