Goodman and his colleagues hypothesize that the "law of diminishing returns" applies to health care. "There comes a point," he says, " when adding more physicians cant lead to any further gains in outcomes." In the case of neonatal care, the fundamental determinant of neonatal outcomes is whether a baby is born premature, a factor that neonatal specialists do not directly influence. And once a sick baby is born, survival may be more related to organization of existing resources and their effective application rather than the sheer quantity of physicians or other resources, Goodman explains.
The team studied the almost 3.9 million infants born in 1995 with a birth weight of at least 500 grams (1.1 pound). The overall mortality rate (measured by death within the first 27 days of life) was 3.4 per 1000 live births. Regions in the United States were grouped based upon the supply of neonatologists per newbornvery low, low, medium, high and very high. After adjusting for factors associated with greater risk of death, such as birth weight or prenatal care, investigators found no difference in the mortality once the supply of neonatologists exceeded the "low" supply category.
The death rate was 7 percent less in regions with 4.3 neonatologists per 10,000 births than in those with 2.7 neonatologists per 10,000, but further increases in neonatologists made no difference. The low supply regionswith 4.3 neonatologists/10,000 birthshad the same death rate as the highest supply regionsthose with 11.6/neonatolgoists/10,000 births. The research team also looked at the supply of neonatal intensive care beds and found no reduction in mortality as the number of beds increased.
The articles co-authors, who include neonatologists, epidemiologists and statisticians, are: Elliott S. Fisher, MD, MPH; George A. Little, MD; Therese A
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