Yesterday I was in Washington D.C., where the scent of health care reform is as pleasant as the cherry blossoms, for a meeting of the minds on the subject of a particular brand of care: That for pregnancy and childbirth.
Childbirth is the number one reason why someone is admitted to the hospital (more than 4 million babies are born in the US every year) and the biggest contributor to the cost of health care, comprising 17 percent of the country’s GDP. About 47 million people are uninsured in this country and many more are underinsured.
So the topic is huge, no pun intended.
About 150 thought leaders from around the country attended "Transforming Maternity Care: A High Value Proposition," a confab to make evidence-based care a national conversation.
Long overdue, in my book, given that the national c-section rate is at an all-time high of nearly 33 percent, and other procedures and interventions endure despite research showing they should be a last resort, not the first. But evidence-based care isn’t always enough to change the behavior of consumers, doctors or public policy makers. There needs to be a carrot and a stick.
There were many great recommendations from the conference which have broader applications throughout the health care universe. I am going to dole it out one post at a time over the next week or so.
Starting with:
In the absence of a consumer groundswell, we need to change the system, specifically, we need a new payment system. Right now we pay for procedures. An overhauled system would reward good evidence-based practices (and discourage those that are not). For example, steer payments toward things such as providing a safe environment for VBACs, offering smoking cessation programs and diabetes control; don’t reward the overuse of technology, don’t reimburse elective inductions at 39 weeks. What if insurers paid more for first-trimester visits than third-trimester visits? Paid more for vaginal births than c-sections? Paid more for midwives than physicians?
I think we all know birth would be different in America.
6 comments:
~Melissa
www.nursingbirth.com
Sounds like a great idea to me! And it seems to be working somewhat in Brazil. In Brazil, the cesarean rate in private hospitals is about 93% and approximatly somewhere between 30-50% in public hospitals. As Marsden Wagner writes in his book "Born in the USA", there were conferences held in Fortaleza in 1985 & 2000 where the goals were to demedicalize and humanize childbirth. He writes, "In the years following the two conferences, there was a lot of anger among women in Brazil over their maternity care, and coalitions were formed to work for a better system. These groups have worked closely with the national government in Brazil to change the country's policy for reimbursing public hospitals for C-sections--hospitals with excessive C-section rates are not reimbursed by the government for these unnecessary surgical procedures." (page 217)
Oh, the potential of national health care in America... A girl can dream can't she!?
~Melissa
www.nursingbirth.com
Melissa, Marsden Wagner spoke about this at the conference, saying that instead of the Brazilian government focusing on training OBs to do surgery they focused on training midwives to assist with normal birth. Sounds like it is working.
Yes, let's just hope that if the pay was higher for midwives than OB's that all terrible OB's wouldn't become midwives...
Blessings!
Dawn
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