Deregionalization of neonatal intensive care in urban areas.
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.
Howell
Embry M
EM
Mathematica Policy Research Inc, Washington, DC. ehowell@ui.urban.org
Richardson
Douglas
D
Ginsburg
Paul
P
Foot
Barbara
B
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