Medical Professional Liability and the Delivery of Obstetrical Care Volume II, An Interdisciplinary Review (1989) / Chapter Skim
Currently Skimming:
Obstetrical Care for Low-Income Women: The Effects of Medicine Malpractice on Community Health Centers
Obstetrical Care for Low-Income Women: The Effects of Medicine Malpractice on Community Health Centers
Pages 59-77
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 59... ...
Rising premiums for malpractice insurance and escalating numbers of lawsuits have transformed obstetrics for providers and patients alike. Among the most dramatic changes has been the exodus of obstetricians and family doctors from obstetrical practice.
|
From page 60... ...
The extent to which women are uninsured or publicly insured is especially important in a discussion of the delivery of maternity care because of the pivotal role that health insurance plays in the accessibility of care. The GAO found that less than one-third of uninsured women received adequate prenatal care, compared with 81 percent of insured women.~° As a declining proportion of women of childbearing age are insured, obstetricians' ability and willingness to practice an expensive form of medicine are also likely to decline.
|
From page 61... ...
Physicians' fears of malpractice suits have disproportionately affected access to care for poor women because of a widely held but unsubstantiated perception among physicians that poor women are more litigious than nonpoor women.~4 Physicians who do not serve Medicaid patients report that this perceived litigiousness is among the principal reasons for their not taking Medicaid patients.~5 Data are limited on the extent to which this crisis has affected care for low-income pregnant women, although the data that are available suggest that poor women may be less rather than more likely to pursue a malpractice incident. There is ample documentation that providers who are able or willing to serve uninsured and publicly insured pregnant women are in limited supply, but these data do not always distin
|
From page 62... ...
That year, the centers provided maternity care to 120,000 pregnant women, more than half of whom had family incomes below 100 percent of the federal poverty level. Second, in numerous communities the health center is the only provider willing to accept Medicaid and uninsured patients.
|
From page 63... ...
The capacity of the staffs and the strength of the contractual arrangements determine the availability, accessibility, and quality of care that centers can provide. We hypothesized that the malpractice climate especially rising insurance premiums and the threat of litigation—may have reduced the centers' capacity to provide maternity care in various ways.
|
From page 64... ...
Some centers that have actually experienced such claims may have elected not to complete the survey. In that case our sample would represent a disproportionate number of centers without claims, whereas centers TABLE 1 Distribution of Total and Responding Health Centers, by Region, 1988 Public Health Service Region Total Centers Responding Centers Number Percentage Number Percentage I (Me., Vt., N.H., Mass., Conn., 37 7 5 9 R.I.)
|
From page 65... ...
If so, the data from this survey on the severe difficulties of health centers become even more troubling because the responses would not include centers that have actually experienced malpractice litigation. RESULTS The vast majority of health centers reported that medical malpractice issues either directly or indirectly affected the provision of maternity care.
|
From page 66... ...
The professional liability climate affected health centers in two major ways: (1) by reducing their capacity to furnish or purchase maternity care through staff or contract providers and (2)
|
From page 67... ...
Affected centers reported that their existing maternity care systems were threatened or weakened because rising medical malpractice insurance costs or the specter of litigation, or both, limited their ability to recruit and retain staff or to establish and maintain contractual arrangements. Provider Recruitment and Retention Since their inception, Community and Migrant Health Centers have had difficulty recruiting and retaining physicians because of the relatively low salaries they must pay, their isolated locations, and the TABLE 5 Arrangements for Providing Maternity Care Among Responding Health Centers, 1987 Arrangement .
|
From page 68... ...
T~renty-five (46 percent) of the 54 responding centers that reported furnishing maternity care stated that the high cost of medical malpractice insurance limited their ability to recruit and retain maternity care providers.
|
From page 69... ...
Six responding centers were unable to provide care to any pregnant patient because they could neither provide care on site nor contract with other providers.* Of these six centers, five cited the high cost of providing obstetrical care, including rising medical malpractice insurance premiums, as the major reason for not offering maternity care.
|
From page 70... ...
Increased Risk for Family Doctors As a matter of economy, most health centers with maternity care providers on staff employ family doctors rather than obstetricians.
|
From page 71... ...
Many centers in our survey, however, were unable to develop backup or referral arrangements, and the family doctors and midwives were placed in the untenable position of having to choose whether to drop the patient at the time of delivery (and hope that she could make it to the emergency room) , deliver a baby without malpractice coverage, or cease furnishing prenatal care altogether.
|
From page 72... ...
b These practitioners provided prenatal care only. None was allowed to deliver babies under the insurance policy.
|
From page 73... ...
Much of this cost will be attributable to obstetrics-related activities. This $30 million expenditure on malpractice insurance represents 7 percent of the centers' total budget—sufficient funding to build about 60 health centers in medically underserved areas or to increase by one-third the funds now being spent by health centers on maternity care.
|
From page 74... ...
RECOMMENDATIONS Based on our findings, we recommend two immediate, short-term reforms. First, all health center staff end contract providers engaged in obstetrical work should be brought under the protection of the Federal Tort Claims Act (FTCA)
|
From page 75... ...
Second, we believe that a substantial expansion of the National Health Service Corps is warranted. Even if the immediate financial burden of malpractice insurance were lifted, clinics would continue to experience enormous difficulties in recruiting and retaining qualified personnel, given the areas and populations they serve.
|
From page 76... ...
1985. Paying for maternity care.
|
From page 77... ...
1986. The Medical Malpractice Claims Experience of Community and Migrant Health Centers.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.