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December 3, 2007

Yes Andrew, Perhaps Michael Moore Should Run a Taxi Service - But in the Other Direction

Andrew Samwick:

Perhaps Michael Moore Should Run a Taxi Service, Vox Baby I don't know which of the following statements is more surprising. From the AP:

A 35-year-old Canadian woman has given birth to rare identical quadruplets, officials at a Great Falls hospital said Thursday. Karen Jepp of Calgary, Alberta, delivered Autumn, Brooke, Calissa and Dahlia by Caesarian section Sunday afternoon at Benefis Healthcare, said Amy Astin, the hospital's director of community and government relations.

The four girls were breathing without ventilators and listed in good condition Thursday, she said.

Wonderful. And this part:

The Jepps drove 325 miles to Great Falls for the births because hospitals in Calgary were at capacity, Key said.

"The difficulty is that Calgary continues to grow at such a rapid rate. ... The population has increased a lot faster than the number of hospital beds," he said.

For those of you unclear on the geography, their trip looked something like this and would take about five hours at the posted speed limits. About halfway through the trip, they would pass through Lethbridge, which is home to Chinook Regional Hospital, which claims to offer a "high level neonatal intensive care unit." Not good enough? No beds there either? When they were in Lethbridge, they were about an hour away from Medicine Hat, home to this fine institution and its NICU, or two and a half hours plus a border crossing away from Great Falls. They chose the latter.

UPDATE (8/20): At the prompting of a commenter, I found that the doctor's statement about them driving the 325 miles is incorrect, and so too is my travelogue in the last paragraph of the original post (now italicized). Here is a report from the BBC that explains:

A medical team and space for the babies had been organised for the Jepp family at the Foothills Medical Centre in Calgary but several other babies were born unexpectedly early, filling the neonatal intensive care unit.

Health officials said they checked every other neonatal intensive care unit in Canada but none had space.

The Jepps, a nurse and a respiratory technician were flown 500km (310 miles) to the Montana hospital, the closest in the US, where the quadruplets were born on Sunday.

My apologies for the hasty and incorrect post, though this notion that "every other neonatal intensive care unit in Canada" had no space is more of an indictment of the system than my original remarks.

I'm not sure why going to extraordinary lengths to solve a peak load problem shows the inferiority of the system rather than a commitment to serve patients. This wasn't one infant, this was quadruplets, so it's hardly typical -- space for four babies all at once can be hard to find. According to this report, it's true that the U.S. has more beds per live birth than Canada, "The United States has 3.3 neonatal intensive care beds per 10000 live births, while Australia and Canada have 2.6." But that doesn't seem like a huge difference (by the way, the data were collected in an attempt to explain why health outcomes for infants are worse in the U.S. even though resource usage is higher, so maybe that taxi service Andrew calls for ought to run in the other direction).

This is somewhat dated (1991), perhaps things have improved since then, but since we're telling anecdotes and extrapolating to whole systems, maybe that doesn't matter (though this does present actual evidence as well). It indicates that our system also has its problems:

As More Tiny Infants Live, Choices and Burden Grow, NY Times: ...[A]s advances allow medicine to save more and more babies, the demand for neonatal intensive care has risen and existing units are bursting at the seams. ... As a result, most neonatal intensive care units have removed walls to squeeze in a few more beds, and hired nurses to work overtime. Most operate at more than 100 percent of their licensed capacity.

Dr. Dweck, whose intensive care unit serves five counties north of New York City, said he had to turn away 250 babies each year. ...

"Last week there was a 900-gram baby at a community hospital who we knew we could help, but we were horribly overcrowded," Dr. Kleinman said...

Would Canada turn away 250 babies each year in their equivalent of five counties, or would they find a place for them to get the care they need, even if it's in the U.S.?

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