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January 2015

Ensuring Access to the Appropriate Health Care ProfessionalsRegionalization and Centralization of Care in a New Era of Health Care Financing and Delivery

Author Affiliations
  • 1Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 3Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
JAMA Pediatr. 2015;169(1):11-12. doi:10.1001/jamapediatrics.2014.2468

Infants born prematurely continue to make up almost 11.5% of the more than 4 million deliveries in the United States, with 1.4% of these deliveries occurring at a gestational age of 28 weeks or less.1 The work of Kastenberg et al,2 published in this issue of JAMA Pediatrics, adds to the extensive literature showing that delivery at a high-volume/high-level neonatal intensive care unit is associated with lower mortality and morbidity linked with premature birth.35 Given the high cost of delivering care to these infants, estimated at around $26 billion annually,1 neonatal intensive care has been the focus of efforts to regionalize neonatal care, defined as the development of a structured system of care “to improve patient outcomes by directing patients to facilities with optimal capabilities for a given type of illness or injury.”6 Thus, efforts to improve access to these hospitals focus on improved antenatal access to prenatal care; improved identification and transfer of mothers at risk for preterm delivery; and state health policies, such as certificate of need programs, to reduce expansion of neonatal services without justification of community need.7

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