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Reexamining the Organization of  Perinatal Services Systems

For several decades, the reference standard for the organization of perinatal services has been a system design that achieves the principles associated with perinatal regionalization. However, the devolution of governmental authority, the growth of managed care overall and Medicaid managed care programs more specifically, hospital mergers and competition, and changes in the numbers and types of providers available have had an impact on how perinatal services systems are organized across the country.

The WCHPC undertook an activity to explore the nature of these contextual shifts, and to:

  • describe the current organization of the system of perinatal services
  • describe who and/or what is influencing the design and operation of the system
  • identify the perceived impact of the current system on perinatal care and outcomes

A set of 11 "state case summaries" were developed focusing on accountability, services systems structure, and financing of perinatal services. "Reexamining the Organization of Perinatal Services Systems: A Preliminary Report" is one element of the two-pronged project to examine the potential impact of the devolution of governmental authority and the growth of managed care programs on how perinatal services systems are organized across the country.

Based on discussions with MCH Program teams and review of available literature and program documentation, this publication highlights several aspects of perinatal services systems, including the structure of authority, definitions of levels of care, involvement of the state agency and other agencies and organizations, and information on the availability and/or use of data.

In addition, the WCHPC analyzed a parallel set of data relevant to potential community level impacts. This latter information was collected in conjunction with the FIMR evaluation

Briefs resulting from analysis of these data include:

Two manuscripts, focusing on linkages among birthing hospitals and the locus of accountability for perinatal health, are forthcoming.

Faculty taking the lead on this project are Donna Strobino and Holly Grason, with staff member Gillian Silver.



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