title: Deregionalization of neonatal intensive care in urban areas.
abstract: OBJECTIVE
  This report describes the extent of deregionalization of neonatal intensive care in urban areas of the United States in the 1980s and 1990s and the factors associated with it.
  
  
  METHODS
  We conducted a 15-year retrospective analysis of secondary data from US metropolitan statistical areas. Primary outcome measures are number of neonatal intensive care unit (NICU) beds, number of NICU hospitals, and number of small NICUs.
  
  
  RESULTS
  Growth in the supply of NICU care has outpaced the need. During the study period (1980-1995), the number of hospitals grew by 99%, the number of NICU beds by 138%, and the number of neonatologists by 268%. In contrast, the growth in needed bed days was only 84%. Of greater concern, the number of beds in small NICU facilities continues to grow. Local regulatory and practice characteristics are important in explaining this growth.
  
  
  CONCLUSIONS
  Local policymakers should examine the factors that facilitate the proliferation of services, especially the development of small NICUs. Policies that encourage cooperative efforts by hospitals should be developed. Eliminating small NICUs would not restrict the NICU bed supply in most metropolitan statistical areas.
authors.affiliation: Mathematica Policy Research Inc, Washington, DC. ehowell@ui.urban.org
authors.forename: Embry M
authors.initials: EM
authors.lastname: Howell
authors.forename: Douglas
authors.initials: D
authors.lastname: Richardson
authors.forename: Paul
authors.initials: P
authors.lastname: Ginsburg
authors.forename: Barbara
authors.initials: B
authors.lastname: Foot
mesh_terms: D001509:Bed Occupancy; D001724:Birth Weight; D019538:Health Care Surveys; D006742:Hospital Bed Capacity; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data / Q000639:trends*; D007902:Length of Stay; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States