title: Access to maternity care in rural Washington: its effect on neonatal outcomes and resource use.
abstract: OBJECTIVE
  This study sought to ascertain the effects of poor local access to obstetric care on the risks of having a neonate diagnosed as non-normal, a long hospital stay, and/or high hospital charges.
  
  
  METHODS
  Washington State birth certificates linked with hospital discharge abstracts of mothers and neonates were used to study 29809 births to residents of rural areas. Births to women from rural areas where more than two thirds of the women left for care were compared with births to women from rural areas where fewer than one third left for care.
  
  
  RESULTS
  Poor local access to providers of obstetric care was associated with a significantly greater risk of having a non-normal neonate for both Medicaid and privately insured patients. However, poor local access to care was consistently associated with higher charges and increased hospital length of stay only if the patient was privately insured.
  
  
  CONCLUSIONS
  These results indicate that local maternity services may help prevent non-normal births to rural women and, among privately insured women, might decrease use of neonatal resources.
authors.affiliation: Department of Family Practice, University of California-Davis, Sacramento 95817, USA.
authors.forename: T S
authors.initials: TS
authors.lastname: Nesbitt
authors.forename: E H
authors.initials: EH
authors.lastname: Larson
authors.forename: R A
authors.initials: RA
authors.lastname: Rosenblatt
authors.forename: L G
authors.initials: LG
authors.lastname: Hart
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006302:Health Services Research; D017722:Hospital Charges; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay; D008427:Maternal Health Services / Q000458:organization & administration*; D008484:Medicaid; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration*; D014481:United States; D014861:Washington