Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the United States

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 affects 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.