title: Changes in health care delivery: a threat to academic obstetrics.
abstract: OBJECTIVE
  Our purpose was to examine the effect of anticipated health care policy changes on delivery trends at leading academic obstetric institutions.
  
  
  METHODS
  The 51 centers in the United States with the most Society of Perinatal Obstetricians presentations in the past 2 years were surveyed regarding annual deliveries from 1990 to 1993 and reasons for any changes. Analysis of variance and chi 2 analysis were used as appropriate.
  
  
  RESULTS
  Complete data were available from 43 hospitals representing 39 institutions. Their 1990 to 1993 delivery rates declined faster than United States delivery rates (12.3% vs 2.0%, p < 0.0001). The largest hospitals (> 6000 deliveries) had a decline of 18.2% compared with declines of 9.0% for medium and 0.9% for small hospitals (< 2500 deliveries). Regionally the greatest impact was seen in the West and the South, with 22% and 12% declines, respectively (p < 0.05). Reasons cited for the decline included competition from private or community physicians or hospitals (59%) and managed care (15%).
  
  
  CONCLUSIONS
  As the national health care debate focuses on cost containment and coverage, we believe the potential effects of national policy on research and education should be considered. Continued selective reduction in deliveries at academic institutions can be expected to adversely affect research and education.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, MI, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Tomlinson
authors.forename: M P
authors.initials: MP
authors.lastname: Dombrowski
authors.forename: R A
authors.initials: RA
authors.lastname: Bobrowski
authors.forename: S F
authors.initials: SF
authors.lastname: Bottoms
authors.forename: D B
authors.initials: DB
authors.lastname: Cotton
mesh_terms: D003695:Delivery of Health Care / Q000639:trends*; D036861:Delivery, Obstetric; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D009774:Obstetrics / Q000193:education*; D011247:Pregnancy; D012577:Schools, Medical; D014481:United States