Prenatal Care for the Poor:

Is our community positioned to meet the need?

by Rodney Berry & Kathy Strobel

Examining Options

How should our community respond to this challenge? Is there a more effective and compassionate way for us to meet this need? We examine five strategic options:

1. Give the current referral system time to work
2. Re-establish the midwife program with health department
3. Hire an obstetrician at the health department
4. Advocate for policy changes
5. Recruit more obstetricians

1. Give the current referral system time to work

This option suggests that the recent gesture by local obstetricians deserves a chance to succeed. By participating equitably, they can absorb the caseload of pregnant women who are covered by Medicaid and those who are uninsured and unable to pay.

Those who support this option may say ...

Those who oppose this option may say ...

This is a good faith offer on the part of the obstetricians.
Health department officials have expressed their support for this option.
This is the best way to ensure a continuum of care for pregnant women through delivery.

There are not enough obstetricians to absorb this number of patients on a continuing basis; we should plan now for a better way.
Medicaid patients and uninsured pregnant women will be more comfortable in a health department setting.
Obstetricians in private practice may agree to take these patients, but if extra payments are required in addition to the reimbursements offered by the health department, patients will be unable to pay and will have no other alternative for care.

2. Re-establish the midwife program with health department

This option suggests that we should work through concerns that obstetricians have with the midwife program and restore medical oversight so the health department midwife program can be re-established.

Those who support this option may say ...	Those who oppose this option may say ...
The midwife program was popular, safe and cost-effective. Midwives are caring professionals who take time with patients. Many communities rely on trained midwives for deliveries as well as prenatal care. If we are willing to transfer our patients to supervised midwives in Madisonville, we can find a way to do that here at home.	Midwives require medical supervision that is impractical for our small number of obstetricians to provide. Without proper supervision, there are increased liability issues of concern to insurance carriers and state regulators.

3. Hire an obstetrician at the health department

This option suggests that a staff obstetrician at the health department could provide direct services and medical oversight for midwives to restore the prenatal public service.

Those who support this option may say ...

Those who oppose this option may say ...

This option would eliminate the need for local obstetricians to provide medical oversight.
On-site services and supervision would eliminate liability concerns.
The position could be funded by Owensboro Medical Health System or the county health tax. This should be as much or more of a priority than facility expansion or biotechnology enterprises.

The health department should not be in the service delivery business; referring patients to private providers is better.
A private obstetrics practice in the health department would be expensive to establish and subsidize. The public does not support increased health taxes.
A competing obstetrician at the health department would not be welcomed by local colleagues. It would be difficult to secure the back-up support needed for late night and weekend deliveries, vacations, etc.

4. Advocate for policy changes

This option suggests that the key to increased physician care for the poor is to increase Medicaid reimbursements and reduce medical liability insurance premiums.

Those who support this option may say ...	Those who oppose this option may say ...
Obstetricians should not be expected to pay exorbitant liability insurance premiums – much more than other states. In Kentucky, we need a cap on lawsuit awards like they have in Indiana to lower liability awards. Costs of running private medical practices continue to increase while there are unfair expectations that physicians should absorb more indigent care.	This is much more than a local issue; we should focus on local strategies that can make a difference. Caps on individual awards are unfair to consumers; we need to look at other ways to lower liability costs. Physicians are compensated very well and can absorb a reasonable amount of charity and reduced-fee care into their practice.

5. Recruit more obstetricians

This option suggests that if we had more obstetricians in Daviess County, the care of Medicaid and uninsured patients would be more manageable.

Those who support this option may say ...	Those who oppose this option may say ...
We can step up recruiting and perhaps offer incentives to attract more obstetricians to our community Most obstetricians earn exceptional incomes and should be attracted to Owensboro’s high quality of life and growing regional medical position.	Kentucky’s medical liability premiums are substantially higher than many other states and until that changes, obstetricians who want to practice in our area are more likely to set up shop in Indiana. Owensboro-Daviess County has been experiencing stagnant growth for many years. We are not attracting well-educated young people, which is essential for a thriving obstetrics practice.

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