Hospital Mergers, Hospital Choice, and Care Quality for Pregnant Enrollees in Medicaid

Are hospital mergers associated with changes in the hospitals where Medicaid enrollees are admitted for labor and delivery and with obstetric outcomes?In this difference-in-differences study of labor and delivery admissions among 527 499 Medicaid enrollees, county-level exposure to a hospital merger was associated with increased travel distances, shifts in admissions toward safety-net hospitals and away from hospitals with neonatal intensive care units, and a small worsening in 1 quality metric. Other obstetric outcomes did not change significantly; associations varied across urban and rural areas.Hospital mergers may exacerbate access barriers for Medicaid patients, underscoring the need to consider local market structures when developing policies for safety net populations and evaluating mergers.

Corresponding Author: Sunita M. Desai, PhD, Department of Population Health, NYU Grossman School of Medicine, 227 E 30th St, 6th Floor, New York, NY 10016 (sunita.desai@nyu.edu).

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