Changes in the newborn delivery practice and neonatal outcomes as financing changed in Los Angeles County and Orange County, California.

The objective of this investigation was to study changes in newborn delivery during a period of extensive changes in financing mechanisms in Los Angeles County (LAC) and Orange County (OC), California. California hospital discharge data (1990-1999) were used for the analyses. The Herfindahl-Hirschman Index (HHI) was calculated to measure the distribution of newborn deliveries among hospitals. Birth outcomes, including cesarean section rates, in-hospital deaths, interhospital transfers, and selected neonatal morbidities, were assessed. A total of 2,351,209 newborn deliveries in 124 hospitals were recorded. The number of newborn babies delivered per year decreased by 21% during the study period. A dramatic decline in the number of deliveries (up to 80%) was seen in all four LAC county hospitals. The cesarean section rate increased for Medi-Cal patients during the study period, compared with no change in the rate for privately insured patients. The newborn interhospital transfer rate for patients in LAC remained unchanged. The newborn in-hospital mortality rates for both LAC and OC decreased during the study period.