2002 Klein M, Johnston S, Christilaw J, Carty E. (2002). Mothers, babies, and communities: Centralizing maternity care exposes mothers and babies to complications and endangers community sustainability. Can Fam Physician, 48(7): 1177-9, 1183-5.
Under budgetary strains, regional health authorities across Canada are looking to cut costs by restructuring and consolidating services. Often undertaken in the guise of regionalization, centralization frequently appears to be applied without considering the consequences to patient and family care. Regionalization is distinct from centralization. Regionalization is the rational organization of services among level I, level II, and level III facilities, recognizing the contribution of all levels to the care and support of patients, practitioners, and communities.
In maternity care, for example, a well developed system of regionalization would lead to all premature infants being delivered in a level III facility, and all women with severe preeclampsia giving birth in a level II or III centre. On the other hand, in such a system, women at term and expecting an uncomplicated pregnancy and birth would be best served at level I or II facilities close to their homes, where they would have support from family and friends. In fact, the average-sized term baby does best in a level I or II facility. When women requiring level I or II care are in a level III environment, there is a tendency to apply technologies that benefit women in need of such care to all women, and to inadvertently “cause” poorer outcomes for women needing less intervention.
[Available here: http://www.cfp.ca/content/48/7/1177.long]