Organization/Delivery of Health Care

America uses more neonatal intensive care than other developed nations, but infant survival is not consistently better

The United States has substantially greater neonatal intensive care resources per capita than Australia, Canada, and the United Kingdom without having consistently better infant survival, finds a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00070). This calls into question the effectiveness of the current distribution of U.S. reproductive care resources and its emphasis on neonatal intensive care, according to the Dartmouth Medical School investigators who conducted the study. They compared selected indicators of reproductive care and mortality from 1993-2000 through a systematic review of journal and government publications and interviews with leaders in perinatal and neonatal care in the four countries.

Unlike the United States, the other countries provide free family planning services and prenatal and perinatal physician care, and the United Kingdom and Australia pay for all contraception. The United States has high neonatal intensive care capacity, with 6.1 neonatologists per 10,000 live births; Australia has 3.7; Canada, 3.3.; and the United Kingdom, 2.7. The United States also has 3.3 intensive care beds per 10,000 live births; Australia and Canada have 2.6; and the United Kingdom has 0.67.

Compared with the United States, the relative risk of neonatal mortality for infants weighing less than 2.2. pounds was 0.84 (1 is equal risk) for Australia, 1.12 for Canada, and 0.99 for the United Kingdom; for 2.2 to 5 pound infants, the relative risk was 0.97 for Australia, 1.26 for Canada, and 0.95 for the United Kingdom. The notably higher rates of low birthweight infants in the United States account in part for the Nation's high mortality rates. Although neonatal care is indisputably vital to some infants' survival, perhaps there is a threshold where additional neonatal resources yield little measurable benefit, note the researchers. They suggest that the United States maintain level neonatal intensive care resources, while improving funding for preconception and prenatal care.

More details are in "Is more neonatal intensive care always better? Insights from a cross-national comparison of reproductive care," by Lindsay A. Thompson, M.D., M.S., David C. Goodman, M.D., M.S., and George A. Little, M.D., in the June 2002 Pediatrics 109(6), pp. 1036-1043.

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