Regionalization of perinatal health care: a lesson learned but lost.

Regionalization of perinatal health care has offered appropriate services to mothers and babies as close to their homes as possible. The need for regionalized service has not changed, but the concept has been challenged by the managed care dictate that patients receive referral services at the least expensive option available that qualifies to give that service by virtue of an assigned designation of level of care. When regionalization first became extant, hospitals qualified as tertiary (highest level) perinatal centers if they had neonatologists on staff. Now, however, far more is required of a hospital if it is to qualify to provide the highest level of care available. The so-called national guidelines of perinatal health care do not clearly specify this, and thus hospitals with limited scopes of perinatal services may still be recognized as tertiary or subspecialty centers. Third-party payers contract with such hospitals to provide tertiary care and are able to do so at a lower cost because these hospitals are not capable of offering more complex and thus more expensive services. However, some patients require the more comprehensive services and are at least initially denied them because of the costs involved. I believe it is improper for third-party payers to dictate what services patients receive and where they receive them. This has been and should be the province of physicians and physicians alone. Furthermore, I believe that a more detailed and descriptive system of guidelines for perinatal health care at the state level could help to clarify the true level of functioning of any hospital and thus make it more difficult for third-party payers to opt only for the least expensive services.