Originally Posted by jennica
I can understand why they cover analgesia, but why elective inductions, augmentations, and elective c-sections when these things have been shown to be more expensive and produce less healthy, and therefore more expensive in the long run (e.g. NICU, troubles breastfeeding, etc.), results? Why are they insisting on paying more money for something that is more dangerous for the individuals involved? Are they incredibly stupid, being payed off by hospitals, or is there some other reason that we are missing here?
My guess is, few insurance companies cover elective inductions or non-medically-necessary scheduled c-sections. However... how do they go about proving that a particular induction or c-section *wasn't* for an approved reason?
Say an insurance company declares "ACOG doesn't accept suspected fetal macrosomia as a valid reason for induction or scheduled c-section, so we're not covering it." Then a woman with totally uncontrolled GD makes herself a 15-pound baby, goes into labor at 41 weeks, encounters shoulder dystocia, Gaskin manouver doesn't really work, baby has a broken clavicle and brain damage. Now she sues the insurance company... because if they'd covered induction and/or elective c-section for that reason, the baby *probably* would have been fine. How much money are they going to pay out for a lifetime of brain damage or other disability? Even if the number of cases like that are miniscule, it only takes a handful of multi-million payouts to totally wipe out the savings from NOT inducing women at 38 weeks and then paying for NICU stays and other complications.
One dysfunction with the private health care system is that there's three parties involved: the care practitioner, who is licensed and trained to advise and make decisions; the client, who is receiving care and giving their (hopefully) informed consent; and the payor, who is *usually* an insurance company. The customer isn't taking relative cost into account with their decisions, because they're not paying. The doctor, too, is not taking relative cost into account, unless their agreement with the insurance company results in making more money from HIGHER cost services. But the insurance company, being neither the licensed professional or the consenting client, frequently can't make decisions about what is and is not appropriate care without being vulnerable to lawsuit.
I had Kaiser coverage for the first 26 years of my life, and while there are Kaiser horror stories (as there are with most HMOs and a lot of hospitals), it did largely address this problem. Doctors get paid their salary regardless of what services they provide. They work their scheduled hours no matter how long a patient takes to give birth or recover from surgery or whatever. They work *for* the payor, and therefore have at least some professional interest in controlling costs. My experience with Kaiser is that they were MUCH more inclined to test thoroughly, employ preventive practices, or suggest natural alternatives than your typical private or group practice doctor. They'd rather spend $1500 on that freaky eyeball blood pressure test they gave my mom back in 1980-something and FIND OUT what's causing her neck problems, than pay a lot MORE down the line by not identifying and addressing the problem. They'd rather send me to the HFS for some melatonin than prescribe some expensive sleep drug.
There are many reasons why health care is a market failure, which explains why the US spends so much more on care per person but doesn't get better health out of it. Birth is one glaring example among dozens of where the system just breaks down. I'm not hopeful that we'll improve the situation dramatically without a really drastic change to how we provide and pay for health care in this country, frankly. The insurance companies, for all the power that they DO have, don't have enough to change things on their own. Same goes for the care providers and the patients. Actually, it turns into something of a prisoner's dilemma situation, where each entity is trying to work in their own best interest... even though if they all cooperated, they'd achieve a better outcome, but if any one entity acts selfishly while another cooperates, the cooperator gets screwed.