Accumulating resources in perinatal intensive care centers: market strategies and ethical issues.

Abstract

This paper engages in the ongoing dialog on justice and the health care 'industry'1 and addresses the question of whether market strate gies are consistent with an ethical distribution of resources in health care. As it pertains to the development of perinatal services over the past twenty-five to thirty years in the United States, my short answer to this question is no. Business organization and market-oriented strategies have contributed to the creation and extensive growth of perinatal intensive care centers located in large medical centers. This growth, which has aggravated the neglect of primary care, has been incongruent with known health needs and represents an ethically questionable distribution of resources. Over the past three decades, acute care hospitals and medical sub specialists have been bundling personnel and technology into giant critical care units.2 This activity has superimposed a new level of high intensity services on the medical care system. Perinatal centers, defined in terms of highly trained personnel and complex technological equipment in an organized (hospital) unit of care,3 have participated in and contributed to this trend. They have combined subspecialties providing services around birth: perinatology,4 the obstetric sub division which provides high intensity care before and during birth, and neonatology, the p?diatrie subdivision caring for newborns. Medical care growth and development have commonly been attributed to scientific progress,5 and/or professionalization.6 But the (considerable) scientific and professional achievements have evolved within?and been shaped by?a particular economic environment.7 Influencing both professional and regulatory policies, the market has been more pervasive in determining the basic structure of medical care than commonly thought. This does not mean, however, that hospital administrators' and physicians' use of market-oriented strategies