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Why Hospital Maternity Wards Are Closing · CareTalk: Healthcare. Unfiltered.

• 0:06
  And so how, uh, uh, you know, you're, you're in a unique position because of that to kinda give us a sense as to how the US is doing in terms of maternal and child outcomes versus the rest of the industrialized world.
• 0:18
  How's the US doing in terms of maternal and child outcomes?
• 0:21
  Man, John, we got a long way to go.
• 0:22
  But, you know, part of the reason why I think the single best investment we can make in American prosperity is in maternal health is because maternal health- But wait a second.
• 0:31
  We're the wealthiest country in the world.
• 0:34
  We spend more money on, on healthcare than anyone else in the industrialized world.
• 0:39
  I mean, only I think Norway is close, and, you know, the, the Norway's doing much better.
• 0:44
  Like, how could we have poor, um, maternal and child and baby outcomes?
• 0:50
  Well, uh, let me just say what the outcomes are first.
• 0:53
  A mom today is 50% more likely to die in childbirth than her own mother was.
• 0:58
  So it's not just that our outcomes are poor, but we have a generational erosion in outcomes.
• 1:03
  When I was born in 1982, there were 41 hospitals, or 4,100 hospitals in the country that delivered babies, and now there's half as many.
• 1:12
  And it's because the economics, um, of healthcare in general, as you know better than anyone, John, are insensible.
• 1:19
  But in childbirth, they're particularly rough because absurdly, a hospital loses money when they deliver babies.
• 1:27
  Um, they carry the costs of having to wait for something to happen, but the top-line reimbursement has, uh, basically stayed flat as costs have gone up.
• 1:36
  And so most hospitals that deliver babies are in the red, and we see hospitals shuttering.
• 1:40
  So we have a big access issue, particularly in parts of the country where I'm spending a lot of time these days, where you have to drive farther to get to a hospital that's qualified to deliver your baby than you do at any point in Kenya, uh, in the middle of our country right now.
• 1:54
  In the middle of U- the US, you have to drive farther to get to a hospital than- Than you might in Kenya … the, than the average Kenyan would in the middle of Africa.
• 2:04
  Well, the farthest that a, that a Kenyan would have to drive is three hours.
• 2:08
  Um, and in our country, there are people who have to drive farther.
• 2:13
  Insane.
• 2:14
  So is the problem access or how the pregnancies are actually managed by the system or how moms, moms, you know, the, the, the, the, the, the illness or lack of preparation for moms going into pregnancy?
• 2:30
  Well, maternal health is a bellwether for societal health, and so a lot of our deeper structural issues in our country, like poverty, are reflected in maternal health, racial inequity, all of that.
• 2:41
  A Black mom is four times more likely to die consistently.
• 2:46
  Um, that being said, there are three pieces of the puzzle.
• 2:50
  One is you can't fix what you can't see, and our public health surveillance is a century old, and there's a two-year lag in even knowing what the maternal m-mortality rate is.
• 3:00
  And we weren't even systematically measuring it until eight years ago.
• 3:04
  So that's the first piece is our… We need the right data infrastructure to see what the problem is.
• 3:10
  The second piece is access, but it comes down to both hospitals and workforce, where we're losing both in this area.
• 3:17
  And I would argue one of the highest value health services to society is probably helping families get started.
• 3:23
  25% of all hospitalizations are either a mom or a baby.
• 3:26
  It's a big chunk of it.
• 3:27
  Um, but we don't, we don't physically have the hospitals and the people to deliver the services.
• 3:33
  And then the third part is what you're saying, and it gets back to the Checklist Manifesto, is making sure people are actually doing the right things.