Intensity, stratification, and risk in perinatal care: redefining problems and restructuring levels

Area of Science:

• Public Health
• Health Policy
• Maternal Health

Background:

• Inappropriate interventions and inequitable access are significant, yet poorly understood, problems in US perinatal care.
• These issues are intrinsically linked to the organizational structure of the perinatal system, particularly its tiered levels of care.

Purpose of the Study:

• To examine the relationship between the structure of perinatal care levels and the problems of inappropriate intervention and inequitable access.
• To analyze how professional policies, regulatory reforms, and market forces have created a system of care levels based on specialist and technological capacity.

Main Methods:

• Policy analysis
• Systems analysis
• Conceptual analysis of risk and levels of care

Main Results:

• The expansion of "higher" levels of perinatal care has led to oversupply and discriminatory utilization.
• The concept of risk, while used to justify levels of care, also mirrors the existing stratified structure.
• Current system structures contribute to both inappropriate intensity of care and stratified access.

Conclusions:

• Addressing inappropriate intensity and stratified access in perinatal care requires more than conceptual redefinition.
• Fundamental restructuring of the levels of perinatal care is necessary to achieve more equitable and appropriate care delivery.