March 2023

IZA DP No. 15987: Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the US

published in: American Economic Journal: Applied Economics, 2024, 16 (3), 113–141

Over the last few decades, health care services in the United States have become more geographically centralized. We study how the loss of hospital-based obstetric units in over 400 counties affect maternal and infant health via a difference-in-differences design. We find that closures lead mothers to experience a significant change in birth procedures such as inductions and C-sections. In contrast to concerns voiced in the public discourse, the effects on a range of maternal and infant health outcomes are negligible or slightly beneficial. While women travel farther to receive care, closures induce women to receive higher quality care.