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Privately insured moms get more birth interventions - Page 2

post #21 of 28
greaseball that's a good question about the uninsured not being offered options to decline students/residents. I'm going to ask around here and see how that works.
post #22 of 28
Quote:
Originally posted by lena_girl
It really makes me wonder if they offer all these "interventions" for a healthy pregnancy or to make more money from my care?
I think making it profitable is part of the equation... the other part is liability. They don't want to be sued...
post #23 of 28
My husband is an OB resident. All of his months but two are at his home public institution, but those two months at a private hospital really opened his eyes. He says the women at his hospital recive less interventions *because* it is the residents delivering them. My husband works night shifts, he is not on call nights. If you are his patient in labor, their is no incentive for him to dose you with Pit or call a premature c-section because he is not going to sleep or going home, no matter when you deliver! Public Hospitals are a 24 hour a day operation, while many private hospitals are competing with the doctors outside lives, clinics, and schedules. If you do not give birth during my hubbies shift, you will give birth on the next one. He still gets the same crappy paycheck if he attends one birth a night or 25. He gets no higher compensation for a surgical birth than he does a vaginal one. Money and desire to leave the hospital do not cloud his judgement of how to handle patient situations. So, he does the best he can for his patients for the short time he has them. Residents don't suffer from "Failure to wait" syndrome as much as docs in private hospitals do, because it really does not impact them personally at all.

Also the liablity issue, private docs do more montioring and interventions to cover their butts. If it looks like they "did more" it is better for them in a malpractice case than if it looks like they did too little. Docs in public hospitals have less to lose. The hospital pays their insurance premiums, and the hospital is ultimately responsible for all that happens with residents. State hospitals are offered more protection under the law.

As for more interventions equalling more money for docs, fraid not. You get one flat fee for the whole bundle of prenatal care and birth (slightly higher for a c-section). So essentially if a woman comes to the hospital and has the baby in one push, or has a three day ordeal with Pit, forceps, a big tear and repair the doc is usually getting the same preagreed amount form the insurance company.

Oh- and as for the question about being able to deny residents from attending your care in a public hospital. I know in DH's hospital you can say no students observing, but you cannot say no residents, since they are the doctors that primarily staff the hospital. You can refuse treatment form any particular resident, nurse, etc. but not "Residents" as a group. But that goes for both privately and publicly insured patients. (But, lower level resident usually see public patients and they usually give the more experienced residents private patients- shitty, I know).

It is actually pretty amazing how progressive most of the residents DH works with are. They think it is awesome that we are having a homebirth this go-round. All of the female residents use the hospital midwife service when they are having their own babies, and forego most prenatal testing. Dare I say there could be hope yet?
post #24 of 28
Just wanted to add that stats speak for themselves -- compare hospitals! DH's hospital has one of the highest risk populations around (Richmond is the STD capital of the Nation!). Tons of preemies, morbidly obese, and drug abusing moms. But, their C-section rate is 10% lower than any private hospital in town! People are aware of these stats but would still rather deliver at other hospitals --- seems the decor is not fancy enough and you run the risk of seeing poor people in the halls and such. And really, who needs that :
post #25 of 28
Thread Starter 
Quote:
Originally posted by lena_girl
I
One thing I know, the only military spouse women I've ever met who had c-secs from a mil. hospital were those who had a REAL reason for one. After all, they don't want to pay for one unless you REALLY need it.
I agree to some extent. I mean all my pregnancy interventions were done in a military hospital and I now think most of them were unnecessary (but hey hindsight is a wonderful thing!). It was their flagship teaching hospital which is very progressive - rooming in, they promoted BF, NO ONE mentioned formula to me (I was rather annoyed I didn't get a free diaper bag ... and in my area, their episiotomy rate is the lowest because they did some study which found it was unnecessary and not cost effective


Re doctors in training -
I don't have a problem with teaching hospitals using me to train their doctors. I'm quite obliging in that respect. I grew up in a public health system where that is the norm. But I always felt I had a choice - when I got sick of it or didn't feel like it, I'd say so. I've always felt that these inexperienced doctors were well supervised too. All jobs require training - I did when I was training as a counselor and as a social worker. Why should doctors be any different? I think the problem comes if they're taking advantage of young, uneducated people who don't know their rights.

And Greaseball, my dh had liposuction free through the military. The rationale is the doctors need training and our local military hospitals are the main teaching hospitals.... his reason for having it done though was so he could pass the BMI fitness test!!!
post #26 of 28
Quote:
Originally posted by wombat

And Greaseball, my dh had liposuction free through the military. The rationale is the doctors need training and our local military hospitals are the main teaching hospitals.... his reason for having it done though was so he could pass the BMI fitness test!!!
I've got to say, in all my years as a military spouse and growing up as a military child I have NEVER heard of this. BUT, we have never been near any hospital that does any teaching. just the normal clinics and hospitals. I know the military pays for men who have 3 or more kids to get "altered" and pay for laser eye surgery for those who jobs warrent it, but I haven't heard of them paying for cosmetic procedures. Interesting. My husband is a Marine also, and perhaps it would be less common for a Marine to recieve a surgery to help with fitness tests. I have no idea, but I guess you learn something new everyday.
post #27 of 28
Quote:
I don't have a problem with teaching hospitals using me to train their doctors. I'm quite obliging in that respect.
I might not have a problem with one doctor getting some training while working on me, but I wouldn't want a different resident coming in my room every half hour just to get some practice when I didn't even need anything done. I read about women who deliver in teaching hospitals getting a pelvic exam every 30 minutes by a different resident.
post #28 of 28
Thread Starter 
I may as well get really OT now,
lena_girl, I think as long as they think you have a valid reason and you're active duty (no dependents), you can get cosmetic surgery and laser eye surgery here. DH is on the waiting list for the eye surgery too and I can't say his job warrants it anymore than other military jobs. I imagine any active duty could get a referral here to have this kinda stuff done.
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