Healthcare Localization and Utilization: Does Local Supply of Intensive Care Change Admitting Decisions?

Abstract

In recent decades, neonatal intensive care units (NICUs) have proliferated, and this growth in local supply has been suggested as increasing unwarranted intensive-care admissions. In this study, we investigate whether the localization of NICUs causally raises admission rates for healthier newborns. Our event-study results suggest that the arrival of a new NICU increases NICU admissions, primarily for newborns over 1,500 grams. On average, a new NICU increases county-level admissions by 8%, with most new admissions coming from normal birth weight newborns. By contrast, in the full sample, admission rates remain unchanged for the most at-risk newborns, those weighing less than 1,500 grams. However, in low-access areas, NICU arrival increases admission and reduces mortality for the smallest newborns (those under 1,500 grams). Overall, local NICU availability prevents neonatal mortality for the most vulnerable while raising admission rates for healthier newborns.

Note:

Funding Information: This project received no funding.

Conflict of Interests: The authors declare no competing interests.

Keywords: I11, I10, I18, J13, J18 Infant health, pregnancy, intensive care, NICU, health care utilization, health care centralization

JEL Classification: I11, I10, I18, J13, J18.