After decades of delivering babies in the small Wisconsin town of Waupaca, ThedaCare-Froedert Health closed its OB-Gyn unit last month. Experts say that the best for healthcare systems is not always optimal for the public. Especially in rural areas with a sparsely populated population.
By Peter Cameron, the badger project
Since 1954, women in Waupaka and surrounding areas may give birth at local hospitals.
no longer.
Last year, ThedaCare, the healthcare system that runs the hospital, merged with another system, Froedert Health. Last month, its newly formed healthcare system closed its delivery units there.
The closest birth center to Waupaka is currently more than 30 miles to northwest of Stephens Point. But many pregnant women will have to go even further to arrive at hospitals that accept their insurance, says Dr. Russell Bukkiwitz, who worked as a family doctor at Waupaka Hospital for over 30 years, worked for more than 30 years before giving birth to a baby at a baby centre that was closed last year.
“Care will be delayed,” he said. “And that delay in care can have adverse consequences. It may mean harm to the mother. It may mean harm to the fetus.”
Closures are common after the merger, with more people, and therefore have particular stickiness issues in more rural communities, and therefore have little financial implications for profit-driven organizations, said Peter Karstensen, professor emeritus at UW-Madison Law School, which focuses on competitive policy. When competitors merge, they look for areas to reduce costs.
“It almost always means eliminating overlapping activities,” he said.
In Waupaka, that means farewell to the delivery unit. And that's a problem for people in this area. It was repeated throughout the state and country.
The community has tried to provide solutions to the healthcare system and keep the birth centre open, Butokievich said. Waupaca City Council called on the healthcare system to reconsider its closure in December.
The healthcare system told news outlets that it is struggling to recruit doctors and other specialists for the unit, saying most women in Waupaka have already had babies in urban hospitals. However, they also did not display any data supporting these claims, according to news reports.
The Healthcare System did not respond to messages from the Badger Project seeking comment.
Past and future
For over 70 years, the baby in the community was born in a hospital in Waupaka. ThedaCare ruled the hospital in 2006, but continued to stream. Until the merger.
The newly formed healthcare system is technically a nonprofit, but it is still driven by making money, Carstensen said. High-level employees must receive competitive compensation by nonprofit organizations.
“They really run for the benefit of the executives and doctors who are managers and owners of nonprofits,” he continued. “The goal is to increase profits and reduce costs.”
Butkiewicz and others are worried that Waupaca's ThedaCare Delivery Unit is not the only victim of the merger.
They also fear the closure of the birth centre at Tedakare Medical Center in the small town of Berlin, relatively close to the large hospitals in Oshkosh and Fondurak.
Closing there will again increase the size of central Wisconsin territory without a birth center, but Butokievich points out, further extending drive time and escalating the risk of problematic delivery.
The healthcare system did not answer questions about Berlin or other things.
The dominant US model, a profit-centric healthcare problem, is a consistent problem and solutions exist, not wanting to serve areas with few adoption.
If the free market does not meet the needs, the government can intervene to help, Karstensen said.
It can take the form of direct payments to the healthcare system to provide the care needed. Alternatively, the government can promise that an organization will have a monopoly in this region as long as it opens certain services to the public.
The same thing is happening in the state with regard to high-speed internet. Telecommunications providers from many for-profit organizations in rural Wisconsin and rural America have little interest in making the investments they need to bring rapid internet access to their populated customers here. Republicans who control Wisconsin's government initially gave little funding for the issue. But after Democrat Gov. Tony Evers was elected in 2018, he and the GOP-controlled state legislature have significantly increased the amount of internet provider grants to rural areas of the state.
The idea that governments intervene to subsidize the free market is generally more appealing to Democrats than GOPs.
State Sen. Rachel Cabral Guevara, a Republican from Appleton who represents Waupaka and runs her own medical practice as a nurse practitioner, has other ideas to help support medical care in rural areas, or at least help survive.
“Patients deserve access, but first we need to make sure that providers are encouraged to provide these critical services in areas where they need them, especially in high demand areas such as nursing,” she said in an email. “This includes reducing unnecessary red tape, especially in the healthcare industry, for primary care providers.”
To address this shortage of healthcare providers, especially in rural areas, she insisted on allowing them to provide more independence, greater services, greater investment in recruiting and retaining nursing students, and supporting tax credits for nurse educators.
State Senator Kevin Petersen, a Republican who represents the area, did not respond to a message asking for a solution.
No matter what happens, rural healthcare may need some help from somewhere, or much of it may disappear, experts say.
“It's going to involve more regulatory oversight,” Karstensen said. “That's the only way we can try to get results we think are essential.”
Former President Joe Biden's administration has been extremely aggressive about the issue of business competition over the past four years, including challenging many attempts at mergers by large corporations and nonprofits, claiming the outcomes to be worse for consumers. It remains to be seen that President Donald Trump's administration will strongly and strongly enforce antitrust laws in his second term, but the early moves were promising, Karsteinen noted.
The Badger Project is a nonpartisan, civic-backed journalism nonprofit in Wisconsin.
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