Wednesday, October 01, 2003
Keep the U of C midwives In America, health care dollars increasingly are spent on technology to save the sickest patients and on lawyers who sue when medicine fails. Meanwhile, low-cost, non-invasive care is going the way of the dinosaur. Why?
The labor and delivery rooms at University of Chicago Hospitals in Hyde Park have become a microcosm of this health care conundrum. The hospital has told its three midwives that it no longer can afford to spend as much as $180,000 a year to subsidize their practice. The reason, according to Dr. Arthur Haney, the new chair of the obstetrics and gynecology department, is that medical malpractice insurance premiums have tripled in the last three years.
True, medical malpractice insurance rates are growing at an out-of-control pace. But it's hard to believe that is the reason the midwives are being forced out of their jobs. The U of C midwives have never been sued and they are covered under the physicians' malpractice insurance, so closing their practice will not affect malpractice rates.
This isn't about malpractice. It is about health care choice. The University of Chicago is choosing to put its resources into high-cost technology rather than the lower-cost natural approach to childbirth, the foundation of midwifery.
A woman facing painful contractions might be encouraged by a midwife to take a walk or soak in a tub. That same woman who complains to a doctor is likely to first be offered an epidural-adding the cost of the drugs and an another doctor to the hospital charges.
In addition, Caesarean section births are once again on the rise-reaching an all-time high of 26 percent. That's right. One of four births today is a surgical procedure rather than a natural one. And, once a woman has had a Caesarean, she is most likely to deliver subsequent children by C-section. Recently the American College of Obstetrics and Gynecology made a formal recommendation against vaginal births after C-sections.
Does this all add up to better health care? No, it all adds up to more hospital revenues.
Illinois has always been a leader in restrictive practices for advanced degree nurses, including midwives. The reasons always are about the same: “risks,” “high-costs” and “malpractice insurance.” But the logic never holds up.
And there is no logic in the way we pay midwives either. For reasons we don't understand, a normal birth is reimbursed by Medicaid in Illinois at two different levels. For a midwife, the reimbursment is just 70 percent of the physician's rate-even though the same service is performed. The rates are set by the state.
When we went to press, the hospital and the midwives still were negotiating over the future. Women in Hyde Park have mobilized to fight the decision to close down the midwives, so it's possible they will work out a way to continue the practice that started at the hospital in 1985.
We certainly hope so. Not only does it serve women better to give them more health care options, it makes sense on a larger public policy level to ensure that everyone who wants it can get the lowest-cost, least-invasive health care money can buy.
Why so few kids.us Web sites? What if you tried to protect kids from Internet predators and hardly anyone cared? It certainly feels like that was what happened with a new kid-safe Web site, kids.us.
The brainchild of Congressman Jack Shimkus, a Republican from Downstate Illinois, the dot-kids site went live in mid-September.
The site is free of chat rooms and has only sanctioned sites available through hyperlinks. (These are important points, but we also would have gone one step further and banned advertising from the sites.) We were thrilled to log onto www.kids.us-until we realized all roads lead to the Smithsonian Institution. Click on any link-Arts & Entertainment, Our World, Sports & Recreation, Other Cool Stuff for Kids-and end up at www.smithsonian.kids.us.
It's not that we don't like the Smithsonian. It's great. But kids.us was supposed to be more than one link. How about a little PBS Kids or maybe Disney? What about Sports Illustrated for Kids? Those are good Web sites but kids can't get there from kids.us. Officials at kids.us say five other companies have submitted their Web sites for review and 10 others are scrubbing their content to ensure it meets kids.us guidelines.
That's good news. PBS Kids is among the companies readying a site, but a spokesman says it could be several months before all is set.
We are disappointed. This project was announced in February. We would have expected more kid-focused companies to be rounded up by the government and ready to go when kids.us went live on Sept. 4, not just the Smithsonian.