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In Reply.—Dr Cunningham is of course correct in pointing out that abuse of regionalized systems of perinatal care is not restricted to urban areas. My personal experience, however, is that competition for patients by competing systems is more common in urban areas, and, therefore, the problems that I described are more likely to occur in metropolitan areas.
I am delighted that Dr Cunningham amplified the point that technology by itself does not improve care and, when not applied appropriately, may in fact be a two-edged sword.
Kanto WP. Level 2 Hospitals and Regionalized Perinatal Care-Reply. Am J Dis Child. 1987;141(9):939. doi:10.1001/archpedi.1987.04460090015005