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

B B Perkins

    Women & Health
    |January 1, 1994
    PubMed
    Summary

    US perinatal care faces inappropriate interventions and unequal access due to its tiered structure. Restructuring these levels of care is essential to improve equity and reduce unnecessary interventions.

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    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

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    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.