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The impact of high intensity care around birth on long-term neurodevelopmental outcomes


  • Corneliu Bolbocean

    (University of Tennessee Health Science Centre
    The Centre for Addiction and Mental Health)

  • Michael Shevell

    (McGill University)


Background An equitable and affordable healthcare system requires a constant search for the optimal way to deliver increasingly expensive neonatal care. Therefore, evaluating the impact of hospital intensity around birth on long-term health outcomes is necessary if we are to assess the value of high intensity neonatal care against its costs. Methods This study exploits uneven geographical distribution of high intensity birth hospitals across Canada to generate comparisons across similar Cerebral Palsy (CP) related births treated at hospitals with different intensities. We employ a rich dataset from the Canadian Multi-Regional CP Registry (CCPR) and instrumental variables related to the mother’s location of residence around birth. Results We find that differences in hospitals’ intensities are not associated with differences in clinically relevant, long-term CP health outcomes. Conclusions Our results suggest that existing matching mechanism of births to hospitals within large metropolitan areas could be improved by early detection of high risk births and subsequent referral of these births to high intensity birthing centers. Substantial hospitalization costs might be averted to Canadian healthcare system ($16 million with a 95% CI of $6,131,184 - $24,103,478) if CP related births were assigned to low intensity hospitals and subsequently transferred if necessary to high intensity hospitals.

Suggested Citation

  • Corneliu Bolbocean & Michael Shevell, 2020. "The impact of high intensity care around birth on long-term neurodevelopmental outcomes," Health Economics Review, Springer, vol. 10(1), pages 1-12, December.
  • Handle: RePEc:spr:hecrev:v:10:y:2020:i:1:d:10.1186_s13561-020-00279-8
    DOI: 10.1186/s13561-020-00279-8

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    References listed on IDEAS

    1. David Figlio & Jonathan Guryan & Krzysztof Karbownik & Jeffrey Roth, 2014. "The Effects of Poor Neonatal Health on Children's Cognitive Development," American Economic Review, American Economic Association, vol. 104(12), pages 3921-3955, December.
    2. David M. Cutler & Ellen Meara, 2000. "The Technology of Birth: Is It Worth It?," NBER Chapters, in: Frontiers in Health Policy Research, Volume 3, pages 33-68, National Bureau of Economic Research, Inc.
    3. Liran Einav & Amy Finkelstein & Neale Mahoney, 2023. "Long-Term Care Hospitals: A Case Study in Waste," The Review of Economics and Statistics, MIT Press, vol. 105(4), pages 745-765, July.
    4. Prashant Bharadwaj & Katrine Vellesen L?ken & Christopher Neilson, 2013. "Early Life Health Interventions and Academic Achievement," American Economic Review, American Economic Association, vol. 103(5), pages 1862-1891, August.
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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 10th August 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-08-10 11:00:11

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