By NextBestFitStandby payments to keep labor units open
Pay rural labor and delivery units a fixed amount for readiness, not per birth.
Keeps rural labor units open.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Pay rural labor units a fixed readiness payment
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- Maternity care deserts
Paying labor units for readiness rather than per birth keeps births local and reduces risky long drives during labor.
- Getting to care: transportation and ambulances
Standby payments keep births local, reducing the need for long drives during labor.
- Medical errors and poor care coordination
Keeping labor units ready locally reduces risky long drives during labor. Standby payments also keep low-volume units open, where outcomes may be worse.
- Medical errors and poor care coordination
Keeping labor units ready locally reduces risky long drives during labor. Standby payments also keep low-volume units open, where outcomes may be worse.
7 paths soften this
Mandatory error reporting and learning systemMedical errors and poor care coordinationChosenEvery person registered with a primary care homeMedical errors and poor care coordinationChosenStandby payments to keep labor units openMaternity care desertsChosenMinimum nurse staffing ratiosNursing and direct-care shortages and burnoutChosenEvidence-based coverage decisionsLow-value care and overtreatmentChosenShift to small homes and home careNursing home understaffing and qualityChosenNational health record and patient IDRecords don't follow patientsChosen - Raises spending or loosens control over it
Paying labor units for readiness rather than per birth is expensive per birth.
Who's affected
- Pregnant and postpartum people and infants
- Maternity care deserts: Obstetric unit closures leave pregnant people and newborns without local maternity care.
- Rural residents
- Maternity care deserts: Obstetric unit closures leave pregnant people and newborns without local maternity care.
- Getting to care: transportation and ambulances: Closing rural emergency transport services reduce access to care.
- Older adults
- Getting to care: transportation and ambulances: Lack of transportation causes missed appointments.
- People with ongoing or specialist care needs
- Getting to care: transportation and ambulances: Lack of transportation causes missed appointments.
- Medical errors and poor care coordination: Delivery and coordination failures cause preventable harm.
- Hospitals, clinics, and care organizations
- Medical errors and poor care coordination: Fee-for-service providers are paid for treating complications.
- Private ambulance operators
- Getting to care: transportation and ambulances: Out-of-network ground ambulance bills lack surprise-billing protections.
- Hospitals, clinics, and care organizations
- Medical errors and poor care coordination: Fee-for-service providers are paid for treating complications.
- People with ongoing or specialist care needs
- Medical errors and poor care coordination: Delivery and coordination failures cause preventable harm.
- Taxpayers and public budgets
- Raises spending or loosens control over it: Public budgets pay the added spending.
- Link standby funding to quality requirements and transfer agreements
Where it has been tried
- Norway, Sweden: Maternity units funded by budget, not volume.
- Germany: Germany provided €120 million in additional maternity funding independent of service volume in each of 2023 and 2024.