THE REGIONALIZATION OF PERINATAL-CARE IN WALES AND WASHINGTON-STATE

Objectives. The purpose of this study was to compare perinatal regiona lization and neonatal mortality in Wales and Washington State. Methods . The 25 hospitals in Wales and the 80 hospitals in Washington State t hat offered maternity services and the 218 326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to i dentify the neonatal technology and the referral policies of each hosp ital, and linked data from birth and death certificates were used to e xamine birthweight-specific neonatal mortality rates for all babies bo rn in these hospitals. Results. Welsh district general hospitals (broa dly equivalent to Level II perinatal centers in the United States) hav e more sophisticated neonatal technology than their Washington State c ounterparts and appear less likely to refer small or preterm babies to regional or subregional centers. Neonatal mortality rates were quite similar in the two settings. Conclusions. Perinatal care in Wales appe ars to be less regionalized than in a similar region in the United Sta tes. The relative lack of perinatal regionalization in Wales may contr ibute to duplication and underutilization of expensive neonatal techno logies. National health care systems do not, in and of themselves, lea d to optimal regionalization of services.