Trends in perinatal regionalization and the role of managed care.
OBJECTIVE
To describe trends in regionalization of perinatal care and identify factors that predict the extent of regionalization.


METHODS
Data were drawn for four states for every year between 1989 and 1998. Panel data models estimated the effect of managed care enrollment on site of delivery for low, very low, and extremely low birth weight neonates.


RESULTS
Strong evidence for regionalization over time was observed for North Carolina and Illinois, with little change in site of delivery in Washington. A shift from level III to level II hospitals was observed for low and very low birth weight neonates in California. Although managed care enrollment increased substantially in all four states, managed care had no effect on site of delivery; that is, the effect of managed care was near zero and not statistically significant in any state.


CONCLUSIONS
Evidence supports the delivery of high-risk neonates at tertiary care centers. Despite changes in site of delivery, the percentages of very low birth weight neonates delivered at level III hospitals were substantially lower than the goal of 90% set by Healthy People 2010. Financial pressures introduced by managed care cannot be blamed for the failure to meet this goal.


METHODS
II-2.
Dobrez
Deborah
D
Division of Health Policy and Administration, University of Illinois at Chicago, Chicago, Illinois 60618, USA. ddobrez@uic.edu
Gerber
Susan
S
Budetti
Peter
P
D036861:Delivery, Obstetric / Q000639:trends*; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008329:Managed Care Programs / Q000639:trends*; D018743:Perinatal Care / Q000639:trends*; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012041:Regional Medical Programs / Q000458:organization & administration / Q000639:trends*; D012044:Regression Analysis; D014481:United States