Should births be centralised in higher level hospitals? Experiences from regionalised health care in Finland
Article first published online: 24 MAY 2011
© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 118, Issue 10, pages 1186–1195, September 2011
How to Cite
Hemminki, E., Heino, A. and Gissler, M. (2011), Should births be centralised in higher level hospitals? Experiences from regionalised health care in Finland. BJOG: An International Journal of Obstetrics & Gynaecology, 118: 1186–1195. doi: 10.1111/j.1471-0528.2011.02977.x
- Issue published online: 11 AUG 2011
- Article first published online: 24 MAY 2011
- Accepted 1 March 2011. Published Online 24 May 2011.
- Birth outcome;
- centralised hospital services;
- level of care;
- maternity hospitals;
- perinatal care;
- perinatal mortality;
- place of birth;
Please cite this paper as: Hemminki E, Heino A, Gissler M. Should births be centralised in higher level hospitals? Experiences from regionalised health care in Finland. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.02977.x.
Objective To describe: (i) trends in centralisation and unplanned out-of-hospital births; (ii) perinatal mortality by place of birth; and (iii) health and birth outcomes in areas served by hospitals of different levels.
Design Cross-sectional analysis of medical birth register data.
Setting Finland, from 1991 to 2008, and Uusimaa district from 2004 to 2008.
Population All births.
Methods In the hospital-based analysis, birthweight was adjusted by logistic regression. In the area-based analysis results were calculated according to where women lived, grouping them into areas served by different hospitals. The mother’s background characteristics were adjusted for by logistic regression.
Main outcome measures Place of birth, unplanned out-of-hospital birth, perinatal mortality, newborn outcomes, and birth procedures.
Results The number of birthing hospitals declined, the mean number of births per hospital increased, and more births, particularly high-risk births, occurred in university hospitals. Unplanned out-of-hospital births were rare, and their numbers increased in the 2000s, but regional differences declined. Perinatal mortality was higher in the university hospitals than in other hospitals, but after adjusting for birthweight, it was lower. Among children weighing more than 2500 g, mortality was similar for all hospital levels. In out-of-hospital births, perinatal mortality was much higher than in other children. The area-based analysis did not systematically show better or worse results for the areas served by lower level hospitals: after adjusting for the background characteristics of the mothers, all differences were found to be small.
Conclusions The health and service data do not support the need to close down small hospitals in a regionalised system where there is a referral system that functions well.