What we learned trying to tell a complex health policy story amid constant breaking news


By Alan Yu and Nina Feldman

In 2019, Hahnemann Hospital closed in Philadelphia. It was a safety net hospital that cared for many low-income patients, or patients with no health insurance. A lot of hospital staff, patients, and nearby residents were outraged: How could an investment banker close a historic institution as important as this one just because it wasn’t making enough money? 

As the health reporter for Philadelphia’s NPR member station, Nina has covered every twist and turn of this story. But the implications beyond the loss of thousands of jobs and a venerable historic institution weren’t immediately clear. Where would the patients go? Would the remaining hospitals be able to absorb them? Would health outcomes slip? We figured there was no better place to focus than on the maternity wards, since so many had already closed.

Then in 2020, the COVID-19 pandemic forced hospitals to stop doing elective surgeries, which many relied on because these were lucrative procedures that paid for important but non-lucrative services, like labor and delivery, and emergency care. Hospitals suffered, and some filed for bankruptcy or closed

These two pivotal news events for Philadelphia led us to question this country’s unexamined assumptions about health care: It is a business and it should make money, unlike government infrastructure, roads or the military. 

This question is not immediately newsworthy or dramatic. Editors were not interested. 

We thought one way of getting at that larger theme through a focused, local approach would be to see what happened when Hahnemann Hospital closed, including its maternity ward, one of few that remained in the city. Health care workers were very worried when that happened, and they cited a long history of hospitals in Philadelphia closing maternity wards, since that particular service just does not bring in enough revenue. Our hypothesis: closing the maternity ward at Hahnemann would lead to worse health outcomes for pregnant people and their children. 

We soon realized we could not answer that research question.

There wasn’t any data available for 2020 yet, and even if there were, the pandemic transformed health care far beyond the effect one hospital closure would have. Also, the previous research on this topic, which stopped at 2005, showed a more complex trend: the chances of infant mortality rose after maternity wards closed, but then leveled off.

We changed our research question to address those broader issues: What happened when all the other maternity wards closed in the past 20 years? How do we explain the complex outcome?

It was already a difficult story to sell, and we soon found that our story is neither a disaster story, nor a solutions story. No catharsis, and no outrage. 

We leaned on what we had: powerful anecdotes about midwives pushed to the edge from being overworked; pregnant people forced to deliver in hospital hallways due to lack of space; department heads who paid more in medical liability insurance for doctors than they paid those doctors in salaries. We used those anecdotes to carry a radio story, a medium where it is very difficult to present numbers in an impactful way because the audience only listens to a story once, often half-heartedly while driving or falling asleep. 

We talked to department heads, staff who worked in maternity wards and clinics across the city, the former health commissioner, and researchers to paint as complete of a story as we could about what happened when all these maternity wards in Philadelphia closed. 

The 2020 Data Fellowship gave us the training, skills, and mentorship we needed. It was also a useful commitment device: we had to present our story, regardless of how complex it was. 

But after reflecting on the experience, this is what we would have done differently:

  1. Look for data immediately after forming your research question. We had an ambitious plan that included looking through hospital discharge data and working with health researchers who had done some of this work, but we did not have the time or money to do this in the end. Neither did our research partners because this is not their day job and they were taking care of patients during a pandemic. If we had started sooner, we might have had time to connect with someone who gave birth around the time when a maternity ward closed. That is the one perspective we feel is missing from our story. 
  2. Make time for this project during work hours. Our editors are very accommodating, but we are still health reporters during a pandemic — beat reporters at a time when there is constant breaking news. We should have worked out an arrangement early on where we could have devoted days in the week to focus just on this project.  

We will keep working on this. After all, we still want to address our original question as much as we can: What happened because Hahnemann Hospital closed along with its maternity ward? The question of hospital financing for maternity care continues to be relevant: two giant health systems in Philadelphia are cleared to merge, and for the first time, a birthing center will open in 2022

Will the merger lead to less competition and higher health care prices, as previous research indicates? And will the new birthing center overcome the historic hurdle of offering a service that is both vital and unprofitable? 

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