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November 3, 1978

Quality and Cost

Author Affiliations

Salt Lake City

JAMA. 1978;240(19):2082. doi:10.1001/jama.1978.03290190060035

The article by Herman A. Hein, MD, (p 2051) regarding quality and cost of perinatal care in small rural hospitals raises many health-planning issues that are pertinent to current medical and human priorities in perinatal care.

First, a firm definition of "quality" is elusive, and Dr Hein may have been enthusiastic in his selected title. Nevertheless, he does demonstrate an improving perinatal outcome in rural hospitals in Iowa by the use of a "risking out system" and the referral of patients who should give birth at centers where technological expertise is available and economically justifiable for outcome improvement. His writings also demonstrate the value of a regional plan, not judgmentally imposed by national or federal regionalization criterions, but by the human and medical needs of a geographic and possibly cultural unit as in a rural state.

A voluntary, resilient, and adaptive system, using the best of centralized technology for those