Economic and healthcare related determinants of infant health at birth
Watson, Samuel I.
This thesis analyses the effects of various structural and organisational characteristics of specialist neonatal units on the clinical and economic outcomes of infants treated within them. Data are utilised from the National Neonatal Research Database (NNRD) which is extracted from the electronic patient records of all infants admitted to the vast majority of neonatal units in England over the period 2006-13 along with national healthcare expenditure and demographic data. Firstly, I examine the effects of neonatal unit volume and designation on infant clinical outcomes. In 2003, neonatal units in England and Wales were re-organised into networks to facilitate access to high level and volume neonatal units for the sickest infants as infants treated in these units had previous been shown to be at less risk of adverse outcomes. No previous studies have examined the effects of neonatal unit volume and designation in such a networked setting. Secondly, I estimate the effect of neonatal healthcare expenditure on the risk of mortality, and in so doing determine the cost-effectiveness of neonatal healthcare.\ud Thirdly, I analyse the effect of nurse to patient ratios in neonatal intensive care on the risk of mortality, recent evidence has demonstrated that neonatal units are often understaffed with respect to clinical guidelines, yet little is known about the consequences of this on infant clinical outcomes. Finally, I explore the effect of local economic conditions at the time of conception on infant health at birth. The number of admissions to neonatal specialist healthcare units has increased in recent years to approximately 10% of all live births. Understanding the mechanisms underlying this increase is important both for healthcare capacity planning and also development of policies aimed at improving infant health at birth. The results in this thesis support policies aimed at increasing the proportion of infants born in hospitals with high volume neonatal units along with an increased provision of resources for neonatal healthcare.\ud
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