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Supply and demand for neonatal intensive care: trends and implications
1National Perinatal Information Center, Providence, RI 02908, USA.
Objective:
Access to high-risk newborn care is determined by supply of services, demand, and financing. Major changes in health care have occurred since the advent of perinatal regionalization in the mid-1970s. This article explores access from the point of view of the supply and demand for neonatal intensive care within the changing financing environment.
Study Design:
An analysis was done of the 1983, 1989, and 1991 American Hospital Association survey data, combined with birth data from the National Center for Health Statistics.
Results:
By 1991 supply of hospital-based high-risk newborn care exceeded demand; nationally, there were roughly 300,000 excess bed-days available in 1991. Regional figures revealed that these estimates are, if anything, conservative.
Conclusions:
Payers are increasingly price sensitive and have the ability to shift blocks of patients from one facility to another. A surplus encourages a shift of patients to low-price locations. Differentiation of quality and monitoring will become an important means of ensuring access to high-quality care in a surplus environment.