Abstract
Objective:
To determine the impact of state certificate of need programs (CON) on the number of hospitals with neonatal intensive care units (NICU) and the number of NICU beds.
Study Design:
The presence of a CON program was verified from each state's department of health. Multivariable regression models determined the association between the absence of a CON program and each outcome after controlling for socioeconomic and demographic differences between states.
Result:
A total of 30 states had CON programs that oversaw NICUs in 2008. Absence of such programs was associated with more hospitals with a NICU (Rate Ratio (RR) 2.06, 95% CI 1.74 to 2.45) and NICU beds (RR 1.96, 95% CI 1.89 to 2.03) compared with states with CON legislation, and increased all-infant mortality rates in states with a large metropolitan area.
Conclusion:
There has been an erosion of CON programs that oversee NICUs. CON programs are associated with more efficient delivery of neonatal care.
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References
Phibbs CS, Bronstein JM, Buxton E, Phibbs RH . The effects of patient volume and level of care at the hospital of birth on neonatal mortality. JAMA 1996; 276: 1054–1059.
Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH . Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med 2007; 356: 2165–2175.
Cifuentes J, Bronstein J, Phibbs CS, Phibbs RH, Schmitt SK, Carlo WA . Mortality in low birth weight infants according to level of neonatal care at hospital of birth. Pediatrics 2002; 109: 745–751.
Lasswell SM, Barfield WD, Rochat RW, Blackmon L . Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis. JAMA 2010; 304: 992–1000.
Meadow W, Kim M, Mendez D, Bell A, Gray C, Corpuz M et al. Which nurseries currently care for ventilated neonates in Illinois and Wisconsin? Implications for the next generation of perinatal regionalization. Am J Perinatol 2002; 19: 197–203.
Bode MM, O’Shea TM, Metzguer KR, Stiles AD . Perinatal regionalization and neonatal mortality in North Carolina, 1968 to 1994. Am J Obstet Gynecol 2001; 184: 1302–1307.
Powell SL, Holt VL, Hickok DE, Easterling T, Connell FA . Recent changes in delivery site of low-birth-weight infants in Washington: Impact on birth weight-specific mortality. Am J Obstet Gynecol 1995; 173: 1585–1592.
Gould JB, Marks AR, Chavez G . Expansion of community-based perinatal care in California. J Perinatol 2002; 22: 630–640.
Lorch SA, Myers S, Carr B . The regionalization of pediatric health care: A state of the art review. Pediatrics 2010; 126: 1182–1190.
Hellinger FJ . The effect of certificate-of-need laws on hospital beds and healthcare expenditures: An empirical analysis. Am J Manag Care 2009; 15: 737–744.
Ho V . Certificate of need, volume, and percutaneous transluminal coronary angioplasty outcomes. Am Heart J 2004; 147: 442–448.
Ho V, Ross JS, Nallamothu BK, Krumholz HM . Cardiac Certificate of Need regulations and the availability and use of revascularization services. Am Heart J 2007; 154: 767–775.
Ho V, Ku-Goto MH, Jollis JG . Certificate of Need (CON) for cardiac care: controversy over the contributions of CON. Health Serv Res 2009; 44: 483–500.
Conover CJ, Sloan FA . Does removing certificate-of-need regulations lead to a surge in health care spending? J Health Polit Policy Law 1998; 23: 455–481.
Robinson JL, Nash DB, Moxey E, O’Connor JP . Certificate of need and the quality of cardiac surgery. Am J Med Qual 2001; 16: 155–160.
Shortell SM, Hughes EF . The effects of regulation, competition, and ownership on mortality rates among hospital inpatients. N Engl J Med 1988; 318: 1100–1107.
Garrison Jr LP . Assessment of the effectiveness of supply-side cost-containment measures. Health Care Financ Rev Annu Suppl 1991; 13–20.
National Conference of State Legislatures (homepage on the Internet). The National Directory. c2010 Available from: http://www.ncsl.org/default.aspx?tabid=14373http://www.ahpanet.org/.
Blackmon LR, Barfield WD, Stark AR . Hospital neonatal services in the United States: Variation in definitions, criteria, and regulatory status, 2008. J Perinatol 2009; 29: 788–794.
American Academy of Pediatrics (homepage on the Internet). Available from: <http://www.aap.org/securemoc/neoperi/content/NICU.pdf>.
American Academy of Pediatrics Committee on Fetus and Newborn. Levels of neonatal care. Pediatrics 2004; 114: 1341–1347.
Centers for Disease Control and Prevention (homepage on the Internet). National Center for Health Statistics. Health Data Interactive. Last updated 2010 Feb 24. Available from: http://www.cdc.gov/nchs/hdi.htm.
Baker LC, Phibbs CS . Managed care, technology adoption, and health care: The adoption of neonatal intensive care. Rand J Econ 2002; 33: 524–548.
Salkever DS, Bice TW . The impact of certificate-of-need controls on hospital investment. Milbank Q 1976; 54; 185–214.
Cromwell J . Impact of State hospital rate setting on capital formation. Health Care Financ Rev 1987; 8: 69–82.
Vaughan-Sarrazin MS, Hannan EL, Gormley CJ, Rosenthal GE . Mortality in Medicare beneficiaries following coronary artery bypass graft surgery in states with and without certificate of need regulation. JAMA 2002; 288: 1859–1866.
Massachusetts Department of Public Health. 105CMR: Department of Public Health. Last updated 2010 April 2. Available from: http://www.mass.gov/eohhs/docs/dph/regs/105cmr130.pdf.
Phibbs CS, Mark DH, Luft HS, Peltzman-Rennie DJ, Garnick DW, Lichtenberg E et al. Choice of hospital for delivery: A comparison of high-risk and low-risk women. Health Serv Res 1993; 28: 201–222.
Finlayson SR, Birkmeyer JD, Tosteson AN, Nease Jr RF . Patient preferences for location of care: Implications for regionalization. Med Care 1999; 37: 204–209.
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Lorch, S., Maheshwari, P. & Even-Shoshan, O. The impact of certificate of need programs on neonatal intensive care units. J Perinatol 32, 39–44 (2012). https://doi.org/10.1038/jp.2011.47
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DOI: https://doi.org/10.1038/jp.2011.47
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