Medical Professional Liability and the Delivery of Obstetrical Care Volume I (1989) / Chapter Skim
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4 The Impact of Medical Professional Liability on the Provision of Obstetrical Care to Poor Women and Women Served by Medicaid
4 The Impact of Medical Professional Liability on the Provision of Obstetrical Care to Poor Women and Women Served by Medicaid
Pages 54-72
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From page 54... ...
Moreover, the study concluded that the improvements it had noted in its 1982 survey have been reversed, despite a nationwide expansion in the number of medical care providers. Inadequate financing has always been one of the most significant barriers to obstetrical care for low-income women in the United States.
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From page 55... ...
Most of the studies on Medicaid participation were published prior to the current medical professional liability insurance crisis. Examining the relationship between professional liability concerns and access to obstetrical care for Medicaid recipients, therefore, is much like assembling a mosaic.
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From page 56... ...
Beginning in 1984, Congress enacted staged expansions of coverage for low-income women and children. The 1986 Omnibus Budget Reconciliation Act allows states to provide coverage to children and pregnant women with incomes up to the federal poverty level.
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From page 57... ...
The Alan Guttmacher Institute reported that in 1986 40 percent of obstetrician-gynecologists did not serve Medicaidpatients- a participation rate virtually identical to that 10 years earlier, despite an overall worsening of the malpractice problem (AG1, 19871. The primary sources of data on physician participation are the state Medicaid claims payment systems.
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From page 58... ...
Medicaid reimbursements have always tended to be below the average private charge. In 1986 Medicaid fees were an estimated 44 percent of the average nationwide community charge for obstetrical care.
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From page 59... ...
Overall, 60 percent of Medicaid programs and almost 90 percent of MCH programs are experiencing significant problems in provider participation for maternity care. Nine of 10 report that rising malpractice insurance costs have contributed to this problem.
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From page 60... ...
High Insurance Premiums, Low Reimbursement Rates The available evidence suggests that physicians' concerns about professional liability issues can be divided into two categories the cost of malpractice insurance and the risk of being sued. The provider surveys indicate that each is an important factor influencing physicians' decisions.
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From page 61... ...
Alabama 450.00 430.56 Alaska NA NA Arizona NA 625.00 Arkansas 546.25 131.94 California 657.00 736.11 Colorado 510.00 388.89 Connecticut 861.30 NA Delaware 519.00 347.22 District of Columbia 775.00 461.00 Florida 800.00 NA Georgia 800.00 312.50 Hawaii NA NA Idaho 450.00 527.78 Illinois 446.50 708.33 Indiana 533.00 145.83 Iowa 690.00 409.72 Kansas 750.00 201.39 Kentucky 370.00 305.56 Louisiana 445.56 527.78 Maine 500.00 347.22 Maryland 963.00 506.94 Massachusetts 1471.00 NA Michigan 403.02 NA Minnesota 455.00 326.39 Mississippi 623.60 430.56 Missouri 425.00 666.67 Montana 619.00 423.61 Nebraska 478.00 138.89 Nevada 708.57 666.67 New Hampshire 450.00 NA New Jersey 236.00 527.78 New Mexico 354.79 NA New York 550.00 NA North Carolina 409.00 138.89 North Dakota 295.00 319.44 Ohio 386.00 569.44 Oklahoma 750.00 298.61 Oregon 853.24 625.00 Pennsylvania 437.00 222.00 Rhode Island 750.00 NA South Carolina 485.00 152.78 South Dakota 325.00 201.39 Tennessee 725.00 201.39 Texas 686.50 181.00 Utah 518.71 500.00 (continues)
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From page 62... ...
However, due to the complexity of the problem and to providers' professional liability concerns, many program administrators believe that increasing reimbursement levels may only help to stabilize physician participation in their programs, not necessarily increase it. The states are likely to continue increasing their reimbursement rates for obstetrical providers.
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From page 63... ...
Most observers believe that physicians' fear of suit may be as great a barrier to obstetrical care for low-income women as the rate of reimbursement. The committee heard numerous anecdotal reports that physicians perceive reducing care to Medicaid and low-income women as an effective means of reducing their exposure to high-risk patients.
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From page 64... ...
The effects of this incentive system on access to legal services to the poor has not been well documented, but many theorists surmise that because medical malpractice awards are usually based on lost earnings, among other things, attorneys should have less financial incentive to serve poor plaintiffs. The data currently available provide very limited information on the relation of income to medical malpractice suits.
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From page 65... ...
Although the committee concluded that the causal relationships between professional liability issues, changes in obstetrical practice, and access to care for low-income women cannot be precisely documented, the mere perception among physicians that Tow-income women pose professional liability problems constitutes a barrier to care. PROFESSIONAL LIABILITY AND OBSTETRICAL CARE IN COMMUNITY AND MIGRANT HEALTH CENTERS Because health centers are a vital source of obstetrical care for lowincome women, the committee decided early in its deliberations to commission a survey ofthe effects of medical professional liability on the delivery of care in these centers.
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From page 66... ...
Only 33 percent reported that they were unaffected (Tables 4.3 and 4.41. It should be noted that there appears to be little direct relationship between the rapid escalation of professional liability insurance premium costs and the centers' malpractice claims profiles.
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From page 67... ...
claims profiles (National Association of Community Health Centers, 19861. The Department of Health and Human Services estimates that in fiscal year 1989 approximately $50 million of the $446 million health center appropriation will be spent on medical professional liability insurance coverage for staff (unpublished data, Provider Profile 1988, Bureau of Community Health, Delivery, and Assistance, USDHHS)
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From page 68... ...
Problems with Access The most profound effect of professional liability concerns revealed through the survey was the impact on access to maternity care. Fortythree percent of the centers surveyed indicated that they were forced to "turn patients away" because they were understaffed and unable to recruit or contract with enough maternity care providers.
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From page 69... ...
(Three of these centers used informal referral networks to suggest where pregnant patients might go but had no formal contractual system; the remaining three indicated that no such networks existed.) Ofthese 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.
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From page 70... ...
Prohibitive Insurance Costs The results of the survey suggest that professional liability concerns have reduced the ability of nearly every center furnishing obstetrical care to provide or purchase necessary health services for pregnant women. Many centers with adequate staff have been forced to curtail or
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From page 71... ...
The committee is nonetheless persuaded that the effects of professional liability concerns in obstetrics are being disproportionately experienced by poor women and women whose obstetrical care is financed by Medicaid or provided by Community and Migrant Health Centers. REFERENCES Alan Guttmacher Institute (AGI)
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From page 72... ...
1986. The Medical Malpractice Claims Experience of Community and Migrant Health Centers.
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