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.
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.