Soaring malpractice premiums caused a pronounced decrease in North Carolina rural obstetrics providers during the 1980s. The Journal of Health Care for the Poor and Undernourished (1993) reports on a program which appears successful in stemming this reduction.

The Rural Obstetrical Case Initiative (ROCI), established in 1988, provides up to $6,500 annually to physicians who provide obstetric care to the rural poor in connection with a local health department.

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