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Embry M. Howell, PhD, Douglas Richardson, MD, MBA, Paul Ginsburg, PhD and Barbara Foot, MS

At the time of this study, Embry M. Howell and Barbara Foot were with Mathematica Policy Research Inc, Washington, DC. Douglas Richardson is with the Harvard Program in Newborn Medicine (Beth Israel Deaconess Medical Center, Children's Hospital, Brigham and Women's Hospital, and Harvard Medical School) and the Department of Maternal and Child Health, Harvard School of Public Health, Boston, Mass. Paul Ginsburg is with the Center for Studying Health System Change, Washington, DC.

Correspondence: Requests for reprints should be sent to Embry M. Howell, PhD, The Urban Institute, Health Policy Center, 2100 M St, NW, Washington, DC 20037 (e-mail: ehowell{at}ui.urban.org).

Objectives. This report describes the extent of deregionalization of neonatal intensive care in urban areas of the United States in the 1980s and 1990s and the factors associated with it.

Methods. We conducted a 15-year retrospective analysis of secondary data from US metropolitan statistical areas. Primary outcome measures are number of neonatal intensive care unit (NICU) beds, number of NICU hospitals, and number of small NICUs.

Results. Growth in the supply of NICU care has outpaced the need. During the study period (1980–1995), the number of hospitals grew by 99%, the number of NICU beds by 138%, and the number of neonatologists by 268%. In contrast, the growth in needed bed days was only 84%. Of greater concern, the number of beds in small NICU facilities continues to grow. Local regulatory and practice characteristics are important in explaining this growth.

Conclusions. Local policymakers should examine the factors that facilitate the proliferation of services, especially the development of small NICUs. Policies that encourage cooperative efforts by hospitals should be developed. Eliminating small NICUs would not restrict the NICU bed supply in most metropolitan statistical areas.

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