The Concern for Supply-Sensitive Neonatal Intensive Care Unit Care

Carroll, Aaron E.

doi:10.1001/jamapediatrics.2015.1597

Cited by 18 publications

(18 citation statements)

References 12 publications

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“…We found that babies born at hospitals with more NICU beds were more likely to have NICU admissions, which is Table 2 Proportion of births with a given condition that were admitted to a neonatal intensive care unit, overall sample, and variation across hospitals. consistent with prior studies [24,25]. Examination of different hospital processes may allow for creation of standardized protocols or system processes to help reduce unnecessary NICU admissions, and thereby decrease adverse financial, psychosocial, and downstream health effects.…”

Section: Discussionsupporting

confidence: 65%

Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category

et al. 2020

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Objective To examine interhospital variation in admissions to neonatal intensive care units (NICU) and reasons for the variation. Study design 2010-2012 linked birth certificate and hospital discharge data from 35 hospitals in California on live births at 35-42 weeks gestation and ≥1500 g birth weight were used. Hospital variation in NICU admission rates was assessed by coefficient of variation. Patient/hospital characteristics associated with NICU admissions were identified by multivariable regression. Results Among 276,489 newborns, 6.3% were admitted to NICU with 34.5% of them having mild diagnoses. There was high interhospital variation in overall risk-adjusted rate of NICU admission (coefficient of variation = 26.2) and NICU admission rates for mild diagnoses (coefficient of variation: 46.4-74.0), but lower variation for moderate/severe diagnoses (coefficient of variation: 8.8-14.1). Births at hospitals with more NICU beds had a higher likelihood of NICU admission. Conclusion Interhospital variation in NICU admissions is mostly driven by admissions for mild diagnoses, suggesting potential overuse.

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Section: Discussionsupporting

confidence: 65%

Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category

et al. 2020

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“…Also of concern is the rising rate of incubator overuse in the United States (Harrison and Goodman ). KMC advocates would agree with the comments from the editor of JAMA Pediatrics who stated that such overuse might depend to a great extent on the influence of incentives created by market forces, given that “[t]he amount of money to be made by providing more care is much, much larger than the amount gained by providing usual care” (Carroll , 812). So long as the premium of the health care policy can be renegotiated or other cost‐recovery mechanisms can be established, pharmaceutical and biotechnological companies can keep on introducing new products or expanding the use of existing ones (Iriart and Merhy ).…”

Section: Kmc Around the World?mentioning

confidence: 95%

Kangaroo Mother Care in Colombia: A Subaltern Health Innovation against For‐profit Biomedicine

Abadía‐Barrero

2018

Med Anthropol Q

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This ethnographic study presents the origins, growth, and collapse of the first Kangaroo Mother Care (KMC) program, a well-established practice for neonatal care created in 1978 in Colombia. The WHO and UNICEF praised this zero-cost revolutionary technique for its promotion of skin-to-skin contact between premature and low-birth-weight newborns and family members. KMC facilitates early hospital discharge, brings many clinical and psychological benefits, and constitutes an excellent alternative to placing babies in incubators. However, these benefits and political potential against biomedical interventions were undermined after being relabeled as a "reverse innovation," a business concept that encourages corporate investments in low-income countries to develop technologies that can both solve global health problems and boost multinational corporations profits. In response, I propose "subaltern health innovations" as a label for KMC that accounts for the power dynamics in global health between health care initiatives that originate in the Global South and neoliberal configurations of for-profit biomedicine.

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“…Beyond recouping fixed costs, in order for a NICU to directly provide revenue to the hospital and income to the physician, the beds must be utilized. Given these trends and incentives, health policy researchers have suggested that there may be particularly large scope for available supply to increase utilization in NICUs (Carrol, 2015; Harrison and Goodman, 2015), and this paper seeks to identify a causal estimate of this effect.If availability directly leads to additional utilization of neonatal intensive care, a variety of important costs could be incurred. First, there is the economic cost associated with using care beyond the point at which the marginal benefit outweighs the marginal cost.…”

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confidence: 99%

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confidence: 99%

Capacity and Utilization in Health Care: The Effect of Empty Beds on Neonatal Intensive Care Admission

Freedman

2016

American Economic Journal: Economic Policy

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Because geographic variation in medical care utilization is jointly determined by both supply and demand, it is difficult to empirically estimate whether capacity itself has a causal impact on utilization in health care. In this paper, I exploit short-term variation in Neonatal Intensive Care Unit (NICU) capacity that is unlikely to be correlated with unobserved demand determinants. I find that available NICU beds have little to no effect on NICU utilization for the sickest infants, but do increase utilization for those in the range of birth weights where admission decisions are likely to be more discretionary.Amid rising health care costs and the political debate over health reform, excessive utilization of health care is an important topic. One concern is that the availability of supply itself directly leads to additional utilization, or, as Roemer (1961) put it, that "A built bed is a filled bed." Theoretically, physicians and hospitals face financial incentives to provide additional care on the margin when MRI machines, catheterization labs, or hospital beds are available. In addition to overutilization on the margin, these incentives can dynamically lead to further overinvestment in these high fixed cost facilities as providers compete for patients.Regional medical spending and utilization has been found to be correlated with regional differences in physician supply and hospital bed capacity (e.g. Fisher et al., 2000Fisher et al., , 2003Fisher et al., , 2004. However, even controlling for observable demographic characteristics, cross sectional comparisons across regions are not likely to represent causal estimates. As Fuchs (2004) points out, empirically testing the hypothesis that simply the availability of medical resources leads to additional utilization is difficult; it requires variation in supply that is not driven by patient demand and unobserved health conditions. In this paper, I overcome the endogeneity between capacity and utilization by exploiting short-run variation in the availability of neonatal intensive care unit (NICU) beds. Using hospital discharge data from California and New York, I estimate the effect of the number of empty beds available in the NICU the day prior to an infant's birth on the probability that the infant is admitted to the NICU, conditional on hospital-specific month fixed effects. These fixed effects flexibly control for many unobserved factors that might be correlated with NICU utilization and allow the estimates to exploit within-hospital-month variation in the availability of NICU beds. Unlike regional measures of capacity, within-hospital-month HHS Public AccessAuthor manuscript Am Econ J Econ Policy. Author manuscript; available in PMC 2016 December 07. shocks are unlikely to be correlated with patient demand and health characteristics, and I provide empirical evidence to support this identifying assumption.Neonatal intensive care is an important and interesting health care market in which to examine the effect of availability on utilization. It has been cl...

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The Concern for Supply-Sensitive Neonatal Intensive Care Unit Care

Cited by 18 publications

References 12 publications

Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category

Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category

Kangaroo Mother Care in Colombia: A Subaltern Health Innovation against For‐profit Biomedicine

Capacity and Utilization in Health Care: The Effect of Empty Beds on Neonatal Intensive Care Admission

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