We use data from 1983 and 1988 on hospital use in Alabama to examine the decisions of rural pregnant women to bypass the nearest rural hospital providing obstetric services and seek care elsewhere. The proportion of women who made the decision to bypass the nearest rural hospital increased from 40 percent to 45 percent between 1983 and 1988, while the proportion who traveled to metropolitan areas increased from 41 percent to 68 percent. Women with resources appear to choose longer travel distances in order to use hospitals with high birth volumes and high-risk infant services, but women from counties with large Medicaid populations also more frequently bypassed nearby hospitals.

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