The United States spends more on health care than any other nation, yet its maternal mortality rate is the highest among wealthy countries. Theodosia Stavroulaki, a law professor at Saint Louis University, argues that hospital mergers, especially in rural areas, worsen health outcomes for mothers.
Stavroulaki highlights that rural hospitals face financial challenges due to lower patient numbers and a reliance on less profitable Medicaid patients. Mergers, often seen as a solution, frequently lead to cuts in obstetric care. Today, more than half of rural counties have no hospital that provides obstetric care, Stavroulaki observes.
Longer Travel Times, Higher Risks
When hospitals cut obstetric care, pregnant women must travel further. Many obstetric emergencies demand a response within minutes, making increased travel time dangerous. For low-income women, obstacles to traveling, such as taking time off from work or affording child care, might force them to forgo medical care entirely.
Impact on Hospital Staff
Mergers also affect hospital staff, particularly nurses. In areas with only one hospital post-merger, nurses with specialized skills have limited bargaining power, often leading to lower wages. This not only impacts their health but also the quality of care they provide.
Stavroulaki argues that stressed and overworked nurses, or those who quit due to poor conditions, further compromise patient care, including maternal health.
Antitrust Laws as a Solution
Stavroulaki proposes using antitrust laws to address these issues. Under the Hart-Scott-Rodino Act, large mergers must be approved by the Federal Trade Commission (FTC) and the U.S. Department of Justice. She suggests these agencies challenge mergers that decrease access to obstetric care, similar to past cases involving other medical services.
Additionally, Stavroulaki believes the FTC and Justice Department should consider the impact of mergers on worker wages, especially in areas with limited transportation options. While historically focused on patient harm, these agencies have the authority to challenge mergers based on worker welfare.
Regulators could also condition merger approvals on maintaining obstetric care, as seen in a case where merging hospitals committed to preserving pediatric trauma and emergency care for 10 years.
However, Stavroulaki cites studies showing that mergers often fail to resolve financial issues, with improvements coming at the expense of cutting essential services like obstetric care. For decades, U.S. antitrust law has maintained the principle that the benefits of a merger to one group of consumers cannot offset the harms that it causes to another group. Stavroulaki concludes that regulators must do more to reduce the harms caused by hospital mergers, and that antitrust laws can be a powerful tool in protecting mothers and hospital staff.