In the popular media, and occasionally in academic journals, the high rate of infant mortality in the United States is compared with rates in other wealthy countries as evidence of poor US health care system performance. How can a country that spends more than any other in the world have a high rate of infant mortality? But is this a reasonable use of this measure of health system performance? Access to prenatal care may encourage expectant mothers to improve health behaviors and, by managing maternal health problems, may reduce infant mortality and improve outcomes. Similarly, appropriately staffed neonatal intensive care units for infants born with a serious health condition may help reduce rates of infant mortality. Studies have found that understaffing in neonatal intensive care units is associated with poorer health outcomes for low-weight infants (Rogowski et al. 2013).

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Yet those...

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