By Leslie Small
Over the past two decades, the number of neonatal intensive care
unit (NICU) beds has exploded while the overall number of newborns has remained
relatively stable. The result, according to an extensive new study from
Dartmouth University, is that nearly half of all newborns admitted to NICUs in
the U.S. are of normal birth weight — patients who have "less to gain from
intensive care yet are still exposed to the possible adverse effects of a
hospital setting designed primarily for critical care."
One factor driving this trend may be the notion that "more
care is always better," says David C. Goodman, M.D., of The Dartmouth
Institute for Health Policy & Clinical Practice at the Geisel School of
Medicine at Dartmouth College. Then there are the financial incentives, as
"NICU care is expensive, it's well paid for, it generally has high margins
enjoyed by hospitals, and most of it is paid for on a volume basis," he
notes.
Yet from what Goodman has observed, health insurers haven't done
much to curb unnecessary use of the NICU. Why? One reason is that quality
measures are not well developed for newborn populations, he points out. But
also, "it's very easy for providers to push back on managed care interest
in decreasing overuse by claiming that they're just interested in saving
money," he says.
The report — which looked at data from the Centers for Disease
Control and Prevention's National Center for Health Statistics, Texas Medicaid,
and Anthem, Inc. commercial and Medicaid plans — also found that the amount and
type of neonatal care delivered varied considerably across regions and
hospitals. Further, it found that regions of the country with a high proportion
of factors related to newborn illness generally are not the regions with higher
supply of NICU beds or neonatologists
From
Health Plan Weekly
No comments:
Post a Comment