Our survey found that among a population of patients who chose one of two of our municipal hospitals, the majority did so for many of the same reasons given by women in other studies who sought care in other institutions: convenience of location, recommendation of friends and family and familiarity with the hospital. 2 Over 60% of our patients were insured, indicating insurance status was not an important factor in their choice of delivery hospital. Fifty-six percent of patients relied on either their personal experience or the recommendation of a friend or relative.
A recent study3 found large disparities in obstetric care based upon race of the mother as well as the location of and population served by the hospital where these women gave birth. They also determined that site of delivery may contribute to excess morbidity among Hispanic women.4 Differential location of care is a recognized component of structural racism. When looking at disparities in care within the same hospital based upon insurance status, Howell et a found that women insured by Medicaid had similar risks as those insured by commercial plans.5 They suspected that the effects of reduced reimbursement may operate at the hospital level but not at the individual level. Their research also showed that high-Medicaid hospitals could be found in the lowest and highest clusters for severe maternal morbidity indicating that acceptance of more Medicaid patients alone did not explain hospital performance with respect to maternal outcomes.5 It has been shown that “despite great clinical and policy interest, surprisingly few pregnant women use available quality data to choose their obstetric hospital.” 6
Limitations of our study are that it was not a structured or validated survey, the 41.7% response rate and its availability in two languages while almost 25% of New Yorkers are not proficient in English and patients seeking care at NYC municipal hospitals speak over 190 languages.7
In order to effectively reduce maternal morbidity and mortality, we need to listen to those patient populations who are disproportionately served by municipal hospitals and who are at the highest risk. Understanding the patient’s experience, and any barriers to choice, real or perceived, is important to this goal. Future research should focus not only on differences in locations of care but on why patients make choices that have been shown to significantly impact maternal morbidity and mortality.