Why so little progress in regionalization of perinatal care when transport of high-risk neonates remains a substantial risk?

Barriers to regionalization include cost of program implementation and maintenance, lack of policies for maternal transport, and poorly developed reimbursement strategies for maternal and neonatal transport, particularly true for transports with a Medicaid component and for neonatal return transports [15]. Lack of regulatory oversight, a steady increase in the number of practicing neonatologists, and desires of hospital systems to extend patient services have contributed to de-regionalization.