Perinatal regionalization versus hospital competition: the Hartford example

Area of Science:

• Healthcare Management
• Public Health Policy
• Neonatal Care

Background:

• Healthcare competition can disrupt effective regional organizations.
• A Hartford controversy involved a proposed children's hospital merger, prompting community hospitals to upgrade neonatal intensive care units (NICUs).
• Concerns over rising healthcare costs led to an evaluation of regional NICU bed allocation.

Purpose of the Study:

• To document the benefits of perinatal regionalization in a competitive healthcare environment.
• To analyze the challenges and benefits of perinatal regionalization in the 1990s.
• To evaluate the number and location of regional NICU beds.

Main Methods:

• Stakeholder interviews with hospitals, health plans, insurers, businesses, and government agencies.
• Analysis of quantitative data on newborn discharges.
• Consultant evaluation of regional NICU bed needs.

Main Results:

• The existing regional system demonstrated high performance in clinical care, training, referrals, and satisfaction.
• Significant inter-hospital collaboration existed alongside intense competition, with financial disincentives to support regional structures.
• NICU bed adequacy was marginal with maldistribution; recommendations focused on optimizing existing resources and regional infrastructure support, not adding beds.

Conclusions:

• Perinatal regionalization offers improved care at a lower cost but is threatened by competition.
• Active stakeholder cooperation is crucial for maintaining effective regionalization.
• Further research is needed to determine optimal regional healthcare organization.