The United States has the second highest rate of infant mortality in the industrialized world–tied with Malta and Slovakia. New York Times columnist Nick Kristof has dropped this factoid into his column on many occasions, and it has become Exhibit A amongst the chattering classes for the dysfunctional and callus state of the U.S. health care system, which refuses to spend enough to save even blameless preemies.
Today, Slate dissects the statistic and finds that the problem isn't too little money, it's too much. Infant mortality figures in the United States reflects a large number of premature births, and "modern medicine isn't good at preventing prematurity—just the opposite. Better and more affordable medical care actually has worsened the rate of prematurity, and likely the rate of infant mortality, by making fertility treatment widespread." This argument in response to Kristof's stats has gotten a lot of play, especially from a peeved James Taranto of the Wall Street Journal.
But the Slate piece adds another twist:
Today, neonatal intensive care is extremely lucrative, on average costing tens of thousands of dollars per preterm child. Neonatologists are among the highest paid pediatric subspecialists, and neonatal intensive-care units (NICUs, for short) are hospital cash cows—which is why the units are proliferating wildly nationwide. Yet in a startling 2002 New England Journal of Medicine study, David Goodman and his colleagues showed that the regional supply of neonatologists and NICUs bore no relation to actual need, implying that some doctors and hospitals set up shop simply because there was money to be made.
More disturbingly, areas with more beds and doctors don't have lower infant-mortality rates. The authors ominously suggest that "infants might be harmed by the availability of higher levels of resources." They argue that the availability of a NICU may mean that infants with less-serious illnesses may be admitted to one and then "subjected to more intensive diagnostic and therapeutic measures, with the attendant risks." Too many NICUs are also bad for babies because hospitals that handle a high volume of sick preemies have better outcomes. A 1996 study in the Journal of the American Medical Association confirmed this, concluding that concentrating high-risk deliveries in a smaller number of hospitals could reduce infant-death rates without increasing costs.
Conclusion: "Less money and less patient choice sound heretical—but, in this case, eminently sensible."
UPDATE: The first sentence had been corrected. The US has the second highest infant mortality numbers in the industrialized world. As one commenter delicately put it: "In other words, Mali and Rwanda are still a little worse off than the US."