Schwartz R M
National Perinatal Information Center, Providence, RI 02908, USA.
J Perinatol. 1996 Nov-Dec;16(6):483-9.
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.
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.
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.
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.
获得高危新生儿护理取决于服务供给、需求和资金状况。自20世纪70年代中期围产期区域化出现以来，医疗保健发生了重大变化。本文从不断变化的融资环境下新生儿重症监护的供需角度探讨可及性。
对1983年、1989年和1991年美国医院协会的调查数据进行了分析，并结合了国家卫生统计中心的出生数据。
到1991年，以医院为基础的高危新生儿护理供给超过了需求；在全国范围内，1991年大约有30万个多余的床位日。区域数据显示，这些估计即便有误差也是保守的。
支付方对价格越来越敏感，并且有能力将大量患者从一个机构转移到另一个机构。供给过剩促使患者转向低价地区。在供给过剩的环境中，区分质量和进行监管将成为确保获得高质量护理的重要手段。
