Rethinking perinatal policy: history and evaluation of minimum volume and level-of-care standards

J Public Health Policy. 1993 Autumn;14(3):299-319.


Two standards have played a dominant role in policies to organize U.S. perinatal care. Minimum volume (or size) and service levels according to technical capacity have been major components of perinatal regionalization and other reorganization efforts. These standards are consistent with structural definitions of quality of care, but not necessarily with quality definitions according to outcome. Empirical research has not demonstrated a general association between the standards and improved perinatal outcomes, although it has demonstrated improved outcomes for very low birthweight babies. The standards have contributed to the growth and financial stability of tertiary-level services, but economy in terms of lower unit costs has also not been demonstrated. These discrepancies between research findings and the paradigm of a system of large, complex centers have led to conceptual errors in explaining findings, but they have also led to a recognition of uncertainty concerning perinatal service organization.

MeSH terms

  • Bias
  • Female
  • Health Care Costs
  • Health Policy / trends*
  • Health Services Research / trends*
  • Humans
  • Intensive Care Units, Neonatal / organization & administration
  • Outcome Assessment, Health Care
  • Perinatology / organization & administration
  • Perinatology / standards*
  • Pregnancy
  • Pregnancy Outcome
  • Quality of Health Care*
  • Regional Medical Programs / organization & administration
  • United States