Research Objective: High-volume neonatal intensive care units (NICUs) at the tertiary level of care have been shown to reduce neonatal mortality, particularly for low birth weight neonates and others at high risk. NICUs were initially distributed on a regional basis, to assure low cost and high quality. Over the 1980s and 90s, there has been substantial growth in California of lower level, lower volume NICUs with evidence of higher mortality rates. Only 31.5% of low birth weight infants in California were delivered at Level III hospitals in 1990, far below national standards of 90%. This study examines the relationship between competitive factors, the availability of lower level NICUs across distinct regions in California over time, and risk-appropriate admissions to tertiary level NICUs. It explores measures of availability based on regional and population characteristics including race, insurance status, and incidence of very low birth weight, and outcomes including financial charges. Principal Findings: There is significant variation among the 18 regions. However in most cases the percent of very low birth weight births at Level III hospitals declines as the number of maternity hospitals and the percent of lower level NICUs increases. More competitive distribution of hospital admits is significantly associated with greater availability of lower level NICUs, and a smaller number of births per NICU bed. NICU availability is not associated with demand. Inappropriate admissions occur in regions with both high and low concentrations of MediCal coverage.
Learning Objectives: Participants will be able to describe indicators for assessing appropriate availability of neonatal intensive care units (NICUs), assess how competition influences the availability of NICUs in California, and consider how appropriate care is distributed by race and insurance source
Keywords: Competition, Infant Mortality
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.