Is More Neonatal Intensive Care Always Better? Insights From a Cross-National Comparison of Reproductive Care
- 1 June 2002
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in Pediatrics
- Vol. 109 (6), 1036-1043
- https://doi.org/10.1542/peds.109.6.1036
Abstract
Background. Despite high per capita health care expenditure, the United States has crude infant survival rates that are lower than similarly developed nations. Although differences in vital recording and socioeconomic risk have been studied, a systematic, cross-national comparison of perinatal health care systems is lacking. Objective. To characterize systems of reproductive care for the United States, Australia, Canada, and the United Kingdom, including a detailed analysis of neonatal intensive care and mortality. Design/Methods. Comparison of selected indicators of reproductive care and mortality from 1993–2000 through a systematic review of journal and government publications and structured interviews of leaders in perinatal and neonatal care. Results. Compared with the other 3 countries, the United States has more neonatal intensive care resources yet provides proportionately less support for preconception and prenatal care. Unlike the United States, the other countries provided free family planning services and prenatal and perinatal physician care, and the United Kingdom and Australia paid for all contraception. The United States has high neonatal intensive care capacity, with 6.1 neonatologists per 10 000 live births; Australia, 3.7; Canada, 3.3; and the United Kingdom, 2.7. For intensive care beds, the United States has 3.3 per 10 000 live births; Australia and Canada, 2.6; and the United Kingdom, 0.67. Greater neonatal intensive care resources were not consistently associated with lower birth weight-specific mortality. The relative risk (United States as reference) of neonatal mortality for infants Conclusions. The United States has significantly greater neonatal intensive care resources per capita, compared with 3 other developed countries, without having consistently better birth weight-specific mortality. Despite low birth weight rates that exceed other countries, the United States has proportionately more providers per low birth weight infant, but offers less extensive preconception and prenatal services. This study questions the effectiveness of the current distribution of US reproductive care resources and its emphasis on neonatal intensive care.Keywords
This publication has 45 references indexed in Scilit:
- The Relation between the Availability of Neonatal Intensive Care and Neonatal MortalityNew England Journal of Medicine, 2002
- The Changing Pattern of Neonatal Mortality in a Regionalized System of Perinatal Care: A Current UpdatePublished by American Academy of Pediatrics (AAP) ,1999
- Limited comparability of classifications of levels of neonatal care in UK unitsArchives of Disease in Childhood: Fetal & Neonatal, 1998
- The effects of patient volume and level of care at the hospital of birth on neonatal mortalityPublished by American Medical Association (AMA) ,1996
- The impact of extreme prematurity and congenital anomalies on the interpretation of international comparisons of infant mortalityObstetrics & Gynecology, 1995
- Why Infant Very Low Birthweight Rates Have Failed to Decline in the United States Vital StatisticsInternational Journal of Epidemiology, 1994
- The changing pattern of infant mortality in the US: The role of prenatal factors and their obstetrical implicationsInternational Journal of Gynecology & Obstetrics, 1993
- Poverty, technology and recent trends in the United States infant mortality ratePaediatric and Perinatal Epidemiology, 1990
- The Perinatal Paradox: Doing More And Accomplishing LessHealth Affairs, 1989
- Medicare Trends In Ambulatory SurgeryHealth Affairs, 1989