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

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.^3-5 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