The maternity care units in both the United States and China are facing a dilemma that threatens the very foundation of obstetric services. This crisis, while nuanced in its manifestation in each country, shares a common thread of financial strain, staffing challenges, and misaligned incentives that put the future of maternity care at risk.
The American Struggle
In the United States, the situation is particularly dire in rural areas, where more than 200 hospitals have closed their labor and delivery services over the past decade. This trend leaves pregnant individuals in these regions more vulnerable, with higher risks of intensive care unit admission, mortality, and infant mortality. The absence of local maternity care services means that many patients are unable to obtain adequate prenatal or postpartum care, a necessity for ensuring healthy outcomes for both mother and child.
Financial challenges are at the heart of this issue. Small rural hospitals struggle to maintain the staffing levels required for around-the-clock delivery services, making it financially unfeasible to support maternity care with the payments per birth that are adequate for larger hospitals. This has led to a staffing crisis, with fewer obstetricians and family physicians willing to take on the demanding schedule required for obstetric care.
Echoes in China
The situation in China mirrors the challenges faced in the US, as highlighted by Professor Tao Deng from Shanghai First Maternity and Infant Hospital Out-patients Building. He expresses a deep concern for the state of obstetrics in China:
“When the general public is worried about dropping birth rates, I am more concerned with the collapse of obstetrics.”
Like in the US, maternity care units in China are costly to operate, requiring a dedicated surgery team to be on call 24/7. Despite the high stakes involved in giving birth, the national pricing for obstetric services remains low, further straining the financial viability of these units.
The CMI Index: The Last Straw
In China, the introduction of the CMI index-based performance evaluation system has been particularly detrimental. This system penalizes maternity care units for higher rates of natural births, a marker of good performance, leading to a misalignment of hospital incentives that further exacerbates the crisis. Basically, the welfare and initial good will is misaligned with the incentive, and unfortunately, the incentive is strong.
The CMI index-based system is emblematic of the broader issues facing maternity care globally: a lack of understanding and support for the unique challenges and costs associated with providing quality obstetric services. This system, along with the financial and staffing challenges, represents the last straw that threatens to break the camel’s back, pushing maternity care units to the brink of collapse.