FEDERAL health planners, in the first draft of proposed national guidelines for health planning, observed:
Facilities not located in SMSAs [Standard Metropolitan Service Areas] of over 100,000 population should provide at least 500 deliveries annually.... Below 500 deliveries, the quality of care and efficiency are decreased significantly.1
This opinion should be critically examined because it is likely to influence the availability of health care, especially in rural areas. Iowa, for example, with a population of 2.8 million people, has 129 hospitals that provide maternity care; of these, 105 (81%) had fewer than 500 deliveries in 1977.
A questionnaire designed by us was sent to administrators of Iowa hospitals with maternity services. Figure 1 shows the items assessed on the questionnaire. One hundred twenty-eight questionnaires were sent (the tertiary center at the University of Iowa was not included), and 103 responses were obtained (80% ). Four of the hospitals responded
Hein HA, Ferguson NN. The Cost of Maternity Care in Rural Hospitals. JAMA. 1978;240(19):2051–2052. doi:10.1001/jama.1978.03290190029022
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