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!