Supply and demand for neonatal intensive care: trends and implications.

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.