"You will be a better mom because you are a theologian, and a better theologian because you are a mom."

Is it true? In this blog, I explore the interplay and intersection of motherhood and theologianhood.

Thursday, November 5, 2009

I know how to save the healthcare system billions of dollars

No, actually, I don't know how to save the healthcare system billions of dollars. But my little sis does! The following was written by my sister, who is a Certified Nurse Midwife (CNM) and caught both of my babies. She did it as a facebook note and has allowed me to post it here (thanks, sis!). Ann writes:

Hey, guess what? Barack Obama is right. It is possible to cut health care spending AND provide better quality care at the same time. Trust me, I work in one of the most wasteful areas of medicine (OB/GYN). Here are my ideas that could save SOOOO much money. I'm no rocket scientist-these ideas have all been shown to result in cost savings by people way smarter than me.

Hope I don't sound too judgmental here...I could never write this if I were running for office, but here's what I think:

1. Insurance companies should refuse to pay for elective inductions of labor (before 41 wks of pregnancy, no medical indication). NUMEROUS studies show that induction of labor increases the c-section rate and leads to worse outcomes for babies too.

2. Insurance companies should refuse to pay for elective c-sections. If a mom wants a c-section, she should pay for it herself, out of pocket, because it's shown that c-sections yield more complications for moms and babies and are therefore more costly. If a mom wants to take this risk for no good reason, I think it should be on her and not at the expense of insurance companies/taxpayers-SORRY!

3. Hospitals that want to do OB should be required to offer and provide 24hr OB backup coverage for VAGINAL BIRTH AFTER CESAREAN and women should be highly encouraged to chose this option if they are a non-risky candidate. VBAC attempts are shown to result in cost savings and better outcomes...it's a win-win! And if hospitals have competent OBs on staff to appropriately screen out high risk women and act quickly in emergency cases, really bad outcomes should be extremely rare.

4. OB wards should stop pushing epidurals on women. Yes, many women want epidurals, and that's fine. But what about the women who DON'T want them and are told they simply can't give birth without one? In some places the epidural rate is as high as 95%! (So glad the hospital I work at is not like this). Of course an epidural is a good intervention in some circumstances, but many, many women have uncomplicated labors and are MORE than capable of giving birth without them. Epidurals are expensive and occasionally have side effects that lead to increased medical spending (bad fetal heart tones>CS, spinal headaches, back problems, etc).

5. Insurance companies should refuse to pay for all these needless ultrasounds. Women with uncomplicated pregnancies should have 1 ultrasound in pregnancy, and if it's normal, confirms the due date and reveals no evidence of problems with baby, why waste money on more scans? Yes, it's fun to know the sex of your baby, but it's certainly not medically necessary so if you want more than 1 ultrasound just because they couldn't tell if it was a boy or girl, pay for it yourself! News flash-ultrasounds aren't even shown to improve outcomes.

6. Being a "baby friendly" hospital should not be optional. All hospitals that do OB should be required to adopt practices which have been shown to increase breastfeeding rates. Of course breastfeeding can be challenging, so hospitals should have several lactation consultants on staff to help women learn to breastfeed. The public health implications of this are ENORMOUS because numerous studies show that breastfed babies get sick less, and breastfeeding moms are less likely to get breast cancer down the line. Besides, guess who the biggest purchaser of formula is in this country? THE GOVERNMENT! Yes, it's true, WIC (God bless them) provides formula to poor women. We'd all save money if these women breastfed instead! Sounds like health care dollar savings to me, people! http://www.babyfriendlyusa.org/

7. Circumcision-hate to say it, got nothing against it, but insurance companies and taxpayers shouldn't be paying for elective surgery done mainly for aesthetic reasons. If you want your baby circumcised that's fine by me-but shell out the 500 dollars yourself then.

So see...it IS possible to improve quality of care and save money at the same time!!! Wow, I better get off my high horse now. If you have any other suggestions, feel free to add them to the list!


Clara said...

Mostly great suggestions! Though if it were me I might drop the circumcision one. I get the argument, it's not medically necessary, but there are so many cultural and religious issues there that it might not be a fight worth fighting. Though in fact, from what I hear, a lot of insurance companies don't cover circumcision anymore. So maybe that one's already happening.

Otherwise yes, there's really no earthly reason why women should be entitled to elective caesareans or inductions when this is neither cost-effective nor medically advisable. Particularly with respect to the c-sections, I think there'd be a lot of sympathy for this measure.

I have another idea for how to save money on health care. Some deregulation for entry into medical practice would be in order. A larger part of the load should be taken by people with more specific areas of practice, but less general training... people like midwives, for example. :) A very large percentage of people's medical needs could be met by people with a lot less training than an MD gets (and, correspondingly, lower salaries.) Midwives seem like an excellent model for how this could work, because they're perfectly well qualified to deliver a baby under normal circumstances, but also trained to refer their patients to someone else when necessary (for example, those rarer occasions when a caesarean really is needed.) We all want access to highly trained people in the event that something relatively unusual goes wrong with us, but most of our medical needs are more run-of-the-mill, and of course, the great thing about these kinds of less-trained-but-more specialized medics is that they would have lots of experience with the particular things that they do. This, of course, is one of the great things about midwives – they catch a lot of babies, so they come to the job with all the advantages of ample experience.

Theologian Mom said...

Interesting - I definitely agree with you on deregulation for medical practice (as you described it). I think nurse practitioners do a great job. My father-in-law is an endicrinologist (diabetes, hormones, etc.), and they hired a np into their practice. She does a fantastic job treating most basic endicrinology cases.

As for circumcision, I think I might agree with my sis here. I'm not sure what the cultural issue is (other than that most Euro-American males have been circumcised over the past few decades), and for those who it's a religious concern, they most likely have it done at a religious ceremony, not at a hospital.

Or maybe hospitals shouldn't charge $500 for such a quick, simple "surgery." That would also help.

Clara said...

Well, exactly. I'm not too exercised about the issue either way, but I'm also not sure it's quite as simple as saying that the reasons for circumcision are just aesthetic and that it therefore need not be covered. At the clinic I go to (a sort of self-consciously Christian clinic) they seem to be pro-circumcision, and while I frankly don't quite know what the argument is, I'm sure they wouldn't say that it's just an aesthetic preference. One way or another, it's a question overlaid with all kinds of cultural and religious associations; since it seems to raise very strong feelings in a lot of people, and since it's such a simple procedure anyway, I guess I can't get too upset about having it covered.

Anyway, it seems to belong closer to the "epidural" category (things that really aren't medically necessary, but that people might have non-trivial reasons for requesting) than to the "elective caesarean or induction" category. The latter is just a question of the mother's convenience, and is medically inadvisable, so it definitely seems fair to make people pay for that convenience for themselves, if they really insist on having it.

Theologian Mom said...

True enough.

Heart and Hands said...

Hi guys! I'm not so strongly against circumcision...that's why I put it last on the list of ways to save money. Some more current research is suggesting circumcision is a way to cut down on STD transmission. I maintain that there are better ways (like decreased promiscuity), but I still see how a circ might be a simple intervention that improves public health, so insurance may want to cover it. Also, Clara is totally right that there are health care dollar savings to be found with more reliance on CNMs, NPs, PAs, etc. They provide safe care and in my opinion, sometimes better care that is more based on individual counseling and education and less on procedures and tests. Like Clara points out, that's all MOST people require...and then specialists should also be available for the 5% of people that need more advanced care. In my opinion, this would also make THEM happier. My experience working with OBs is that they would much rather handle the interesting, complicated cases (which are often surgical) and aren't that excited about normal vaginal birth anyway. I say FINE! We can each have what we want.

By the way, I have to add that while epidurals are often very much "elective" and not medically required, I do believe that in some circumstances, they are a wise medical intervention that allows for a better outcome. Take the case of a mom who has a strong urge to push long before her cervix is dilated. Sometimes an epidural is the only thing that will take that urge away and protect her cervix from damage. Also, in the case of prolonged labor, sometimes I think an epidural is wise and allows the mom to have a vaginal birth that she would not have had otherwise.