Privately insured moms get more birth interventions - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 28 Old 04-13-2004, 01:36 PM - Thread Starter
 
wombat's Avatar
 
Join Date: Nov 2002
Posts: 2,998
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
This is an interesting story - women in Australia delivering in private hospitals with private health insurance get more birth interventions. The majority of moms deliver in the public health system in Australia. The big public teaching hospitals have the best reputations.

Mothers better off in public hospitals
http://www.heraldsun.news.com.au/com...55E662,00.html

Quote:
The study, based on NSW figures, found privately insured women:
WERE 15 per cent more likely to be induced.
HAD 75 per cent more epidurals.
NEEDED emergency caesareans 4 per cent more often.
WERE almost three times more likely to have an elective caesarean.
One OB is saying that patient requests for c/s and induction is the main reason, along with more junior doctors delivering the babies.

Mind you, there was no mention in the article about how doctors might financially benefit from doing more interventions.

I wonder how much this finding applies to the USA. Do doctors and hospitals feel that patients have more say in getting what they ask for cause they're paying for it?
wombat is offline  
#2 of 28 Old 04-13-2004, 02:09 PM
 
Artisan's Avatar
 
Join Date: Aug 2002
Posts: 5,427
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
I'm not sure how this applies to the US, but it definitely applies to Brazil. Women delivering in private hospitals (with insurance/means to pay) have an 80%+ C-section rate, whereas poor women have C-section rates of around 15%.
Artisan is offline  
#3 of 28 Old 04-13-2004, 02:18 PM
 
Piglet68's Avatar
 
Join Date: Apr 2002
Location: Vancouver Island, Canada
Posts: 11,097
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My understanding is that, in Brazil, the women are actually asking for the c-sections. I remember reading that it's a big status thing there to schedule your c/s.

It's interesting for sure. Usually you think of not having insurance (or having state insurance in a country like the US) as being risky. I think in the US the infant mortality rates are much higher for poor, non-insured mothers. Then you go to a country where they have public insurance, and the private insurance becomes a "system for the wealthy" - next thing you know, everybody's asking for a c-section. Very interesting....and strange!

teapot2.GIF Homeschooling, Homesteading Mama to DD ('02) and DS ('04)  ribbonjigsaw.gif blogging.jpg homeschool.gif

Piglet68 is offline  
#4 of 28 Old 04-13-2004, 03:24 PM
 
Greaseball's Avatar
 
Join Date: Feb 2002
Location: Eugene, OR
Posts: 8,764
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 2 Post(s)
Quote:
Originally posted by sharonal
I'm not sure how this applies to the US, but it definitely applies to Brazil. Women delivering in private hospitals (with insurance/means to pay) have an 80%+ C-section rate, whereas poor women have C-section rates of around 15%.
I heard that even among the poor, the rate is 65%, and that the reason for all this is to keep one's vagina appealing to a man.: (Also that the rate among the wealthy is 95%. Vaginal births must happen only by accident among them.)

People with private insurance are more likely to have professional jobs, and when given only 6 weeks of maternity leave they may be more likely to do whatever they can to make the birth happen at a convenient time. Maybe they try induction first, which often leads to a section.

I find that public patients actually have more interventions (among people I know IRL). They are likely to get an epidural as soon as they arrive, be given pitocin routinely, and be held to a more rigid clock than a woman with private insurance. I think people who have always been poor have been raised with the belief that they are lucky to have a doctor who will see them at all so they better not question anything; just take what's put in front of you and don't complain. Richer women know they can make special requests and have people jump to meet them. They know that if someone wants to take their baby to the nursery or jump-start an already normal labor, they can ask why. They can even switch doctors if they aren't getting the care they want, and doctors know this. In some towns, there is only one doctor who sees all the medicaid patients and he gets to call the shots.

In my state, medicaid pays 70% of hospital care, and the hospital cannot bill anyone else for the extra 30%. Private insurance pays around 95%. So a medicaid patient hospitalized for a vaginal birth with a 2-day stay at $8000 only brings in $5600 for the hospital, while a private patient brings in $7600. There is more motivation to perform interventions on the medicaid patient, to make her delivery cost more.

Poor women may be more likely to be raised with a fear and disgust of their bodies, or told that childbearing is the cause of their poverty, so anything to do with birth is not something they want to be involved with. That could be why it's mostly higher-income women who choose home birth, even though it's cheaper.

If I had to go to the hospital, I'd much rather have private insurance. Public patients are more likely to be ignored - not something I want if I'm sick enough to be in a hospital!
Greaseball is offline  
#5 of 28 Old 04-13-2004, 04:08 PM
 
forestmama's Avatar
 
Join Date: Feb 2004
Location: Central Kentucky
Posts: 96
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I live in a VERY VERY poor part of KY, were it seems like almost everyone has a medical card. There is a lot of teen births and they are encouraged by the health department to get medical cards even if there parents already have private insurance. The intervention I see in this area is HUGE. For one thing these girls are not overly educated and are more pron to going along with whatever the doctor tells them to do and taking anything the hospital dishes out to them because they simply do not know that they have a choice in the matter. I have also noticed that these girls have a higher tendency to make random trips to the hospital during pregnancy if they feel any BH or mild pain because they know they will not have to pay for any of it (medical card pays for 100% of everything) and it seems by the time they actually do go into labor they are rushed through everything just so they can get it over with, if that makes any since. These are also the same girls that are given huge amounts of formula in the hospital to take home (even if they have said they want to bf) because once again the hospital knows the state is picking up the check.
Those are just my personal observations in my area, but I imagine it is much the same in other poverty stricken areas of the U.S.
forestmama is offline  
#6 of 28 Old 04-13-2004, 04:20 PM
 
Greaseball's Avatar
 
Join Date: Feb 2002
Location: Eugene, OR
Posts: 8,764
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 2 Post(s)
That's true...one complaint that doctors and nurses have about medicaid patients is that they show up in the ER for every little thing. That's probably because it's the only place that can't turn someone away.

When I had a medical card in Eugene, Oregon, I was assigned a doctor and when I wanted to make an appointment I had to wait anywhere from 3 months to a year. During that time, my minor medical condition would turn into a serious emergency so of course I went to the ER. I'm in Corvallis now and for some reason even if I have the card when I call my doctor they often tell me I can come in that day! It's always a surprise. I don't know why it's so different in two cities.

So I can see how when these girls keep coming into the ER for non-emergency stuff, if they come in close to the due date the staff may decide to just induce them so they can be done seeing them.

I remember that one episode of Friends where Rachel is pregnant and Joey brings her into the ER because she is having bh ctx that scare her, and after it's over the nurse is telling Joey "You did the right thing by bringing her in!" I know it's just a TV show, but in real life that happens to poor people all the time and they are scolded when they come into the ER because no one else will listen to them. They don't have doctors they can just call whenever they are wondering about something. Prenatal appts are so short they can't ask questions.

I noticed it's mostly poor women who formula-feed as well. You would think it would be the other way around - if you're poor, why not give your baby the food that's free - but no. I think it has to do with the kinds of jobs the poor are likely to have. They probably couldn't get any maternity leave and have to be at work right away, and don't get pumping breaks. And, again, hatred and mistrust of one's own body could make you think that doctors and scientists know how to feed a baby better than you do.
Greaseball is offline  
#7 of 28 Old 04-13-2004, 04:33 PM
 
forestmama's Avatar
 
Join Date: Feb 2004
Location: Central Kentucky
Posts: 96
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I could not agree with you more! I have been on both sides, with my first 2 I had medical card and I have private insurance this time around. With my first 2 nothing was explained, it was just done. If I tried to ask questions they would just either ingnor me or say "well....this IS what you came to us for, if you did not want to be treated you did not have to come in." It makes you get to the point were you are afraid to ask anything. This time around it has been a total different story "Call anytime you have a question (big smile on there face)" "Oh, right this way Mrs. such and such, Oh Mrs. such and such how are you feeling, is it ok if we do this?" In a way it makes me kind of sick. I was just as much a concerned parent when I was on medical card as I am now.......
With my first I was also un-wed and I can not count the number of times this was brought to my attention during my first pregnancy/labor. Like I did not already know I was not married without having it pointed out to me!
But then again it may also have a lot to do with I know more about my rights this time around and I pull attitude right back at them when and if they start there stuff. I guess it's one of those things were you wish you knew then what you know now.
forestmama is offline  
#8 of 28 Old 04-13-2004, 04:49 PM
 
Greaseball's Avatar
 
Join Date: Feb 2002
Location: Eugene, OR
Posts: 8,764
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 2 Post(s)
I'm fortunate to have a doctor who has given me and my family the same kind of care no matter how we were insured. She is very outspoken about equal health care for the poor and for more insurance options for the working poor who don't qualify for medicaid. I did not even get to pick her myself; she was assigned to me by medicaid so it was all out of luck that I got someone good!

I remember in Eugene having both private and public insurance with the same doctor (and I was never told to wait 3 months when I was privately insured!) and she was definitely more likely to prescribe things when I had private insurance. She would write several scripts at each visit. When I had the medical card she would just tell me that my problems all started from within myself; that I needed to relax or get more rest or wash my hands more often.

So it's true that some doctors are intervention-happy only when a patient is insured. Reminds me of when poor women gave birth in slums with illiterate midwives, while rich women went to hospitals with educated male doctors and died from childbed fever.

T
For some reason, my OB records say that I am single! I can't say that affected the treatment they gave me, but still...when I filled out the forms I checked the "married" box!
Greaseball is offline  
#9 of 28 Old 04-13-2004, 05:34 PM
 
onlyboys's Avatar
 
Join Date: Feb 2004
Location: FL
Posts: 3,755
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
At the school I used to teach at (poor, teenaged mothers) the c-section rate was about 40%. Insane.

None of my girls had private insurance.

The breastfeeding rate was less than 1%.

I (the whole staff, actually) did my best to change things and in the last year I was there, we had 2 VBACs and three girls breastfeed. It's mostly a matter of education. And peer pressure. The girls who nursed or carried their children acted "like they do in Africa." And, this was not a good thing, contrary to how I attempted to spin those comments.

Amanda
onlyboys is offline  
#10 of 28 Old 04-13-2004, 05:39 PM
 
lorijds's Avatar
 
Join Date: Jun 2002
Posts: 2,945
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Well, from an inside point of view....we don't get very well reimbursed for interventions. Less well with a medical card, but even insurance doesn't reimburse very well. For example; if we use lidocaine gel, we get reimbursed two dollars. Never mind that a typical amount used costs 4-5 times that much. We still only get two dollars. Or if we put a mom on oxygen, because of heart tones. There is a set amount. Never mind if we go through a ton of o2, we still only get reimbursed for the set amount.

If you come in for a well woman visit, and you want a wart frozen off, we can't charge your medical card or insurance for both. There is no billing code that can be used. We simply get the reimbursement for the well woman check up and eat the extra money it cost us in time and supplies to freeze your wart.

Whenever I hear about doctors doing some intervention just to get the reimbursement, I have to laugh a little. It actually loses us money almost every time we do an intervention. It is cheaper to do NO interventions, for us anyhow. We are considered an outpatient maternity hospital; our reimbursement is similar to a doctor's office or a regular hospital. HOwever, our practice is very small scale, which translates into inefficient. In other words, we aren't baby factories. Maybe on a larger scale it is different? I don't know. It could very well be. I guess if the interventions are designed to speed things up, then they could very well save money, especially in a high patient volume environment. Hmm, that;s a thought. I'll have to think more on that one!

Good points, earlier, Greaseball. I hadn't thought about the fact that people with insurance are more likely to have jobs and leave time that might very well encourage them to induce.

Lori
lorijds is offline  
#11 of 28 Old 04-13-2004, 06:01 PM
 
Greaseball's Avatar
 
Join Date: Feb 2002
Location: Eugene, OR
Posts: 8,764
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 2 Post(s)
Quote:
I guess if the interventions are designed to speed things up, then they could very well save money, especially in a high patient volume environment.
I think that's true in hospitals where patients are charged an hourly rate for some of the rooms. I hear that's why larger hospitals still insist on laboring in one room and delivering in another, so that a few laboring women can be put in one room at once to save space for other patients. It doesn't save money to let one woman have a whole room to herself for 12+ hours.

I've read things from doctors where they tell patients "It's too expensive for me to sit around waiting for someone to give birth." That's probably why they have the time limits on labors, too.
Greaseball is offline  
#12 of 28 Old 04-14-2004, 10:22 AM
 
Tanibani's Avatar
 
Join Date: Nov 2002
Location: Southern California
Posts: 3,052
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Here is a quote from Naomi Wolf's Misconceptions: Truth, Lies and the Unexpected on the Journey to Motherhood
(though far from perfect, it was a book I really enjoyed and I felt was worth reading.)

Quote:
Several European countries, whose health care systems are not profit-driven, make use of the massive data showing the correlation between emotional support and healthy mothers and babies in determining the country’s standard of care: many British mother’s, for instance, are visited at home by a doula, or postpartum nurse, who might help the new mother with the initial caretaking of the baby, offer psychological support, and do medical follow-up in the comfort of the new family’s own home.

What’s the difference in approach? Money. Since pre- and postnatal care and childbearing expenses are paid for by the British government, the British National Health Service stresses adequately supported approaches to childbearing because it is in the policy makers’ best interest to conserve money by avoiding the expense of costly interventions, which also happens to best serve mothers and babies.

Our system too, is driven by money, but fortunately in the opposite direction: American women, who lack national health service, are more likely to have birth experiences influenced by the high profit margin of C-sections and tight hospital and OB/GYN scheduling, as well as by the hospital’s need to create a defensive legal record.


Wouldn't it be nice if OUR hospitals were INCENTED to keep costs down? But they aren't.

There is an interesting Yahoo story today: Rising Hospital Bills a National Crisis

10 - boy
5.5 - girl
Tanibani is offline  
#13 of 28 Old 04-14-2004, 10:40 AM
 
guestmama9924's Avatar
 
Join Date: Mar 2002
Location: Conch Republic
Posts: 2,302
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I have to agree with some others here that in the US, the poor women are the ones abused with intervention. When I was certifying as a doula, I volunteered at a homeless shelter for women and would drive the pg ones to the hospital and stay with them to be the doula.
THESE are the women that would be given free intervention, by residents that needed the practice. By free intervention, I mean free and unnecessary FORCEPS, VACUUM, C-SECTIONS, EPIDURALS, etc.
Poor women are lab rats in major teaching hospitals.

As a former BC owner, I can also say that it in NOT profit driven to give interventions to poor women. Like lori said, when you get $2 for a $10 injection, what's the benefit? none. It is simply experimentation and abuse IMO

As for the richer/insured women, at least here, they are more likely to DEMAND intervention because they know it is covered by their policy. So I can see the correlation there too.
guestmama9924 is offline  
#14 of 28 Old 04-14-2004, 11:03 AM - Thread Starter
 
wombat's Avatar
 
Join Date: Nov 2002
Posts: 2,998
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Tanibani, your quote from Wolf's book says it all!

When I think of the "costly interventions" I've had done in the USA - 2 Level II ultrasounds, an echocardiogram, amnio, genetic testing.... Plus when I was suffering migraines during my pregnancy, the ER sent me to a NEUROLOGIST! They actually scared me by making that referral. I'd only been in the USA a few months so wasn't terribly used to how the USA medical system works - I thought maybe there was awful reason I needed to see a neurologist

I just think if I'd been pregnant in Australia, a lot of these interventions wouldn't have happened. I can only imagine how much my medical treatment here has cost so far.

I've since become more clued in to how things work here. For instance, my dd has chronic constipation and her ped. referred her for testing for cystic fibrosis!!?? I just put my foot down and told her I thought it was a bit far fetched and once I said that, she agreed with me. Doctors here just don't seem comfortable (probably due to the legal system) relying on their common sense and some basic tests - they want to exhaust every possibility, however unlikely it may be. I still find it hard to believe that individual (employed) doctors are profit driven - I'd like to believe that pressure comes from higher up from hospital administrators or the legal system.

I can imagine how the medical system here would treat poor, uneducated moms, especially the younger ones. I saw my sister as a teen mom get lots of interventions with her first baby because she didn't know any better and didn't have the confidence and communication skills to deal with the medical staff.

I found Well Baby Checks to be rather strange here too. In Australia I would only go to a general practitioner if my baby was SICK. I think you'd only go to a pediatrician if referred by a GP who couldn't handle something. WBCs are done by a nurses at a Maternal and Child Health Center located in every community. So I can imagine the cost of even WBCs in the USA is extremely high compared to other countries.
wombat is offline  
#15 of 28 Old 04-14-2004, 11:09 AM
 
guestmama9924's Avatar
 
Join Date: Mar 2002
Location: Conch Republic
Posts: 2,302
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally posted by wombat
In Australia I would only go to a general practitioner if my baby was SICK.
which begs for the Chinese proverb You stop paying the healer when you get sick Only in "civilized" societies do we PAY when we get sick. Yeah- there is an incentive to keep ya well! I say keep them on the bank roll and with hold payment when you are ill!:LOL
guestmama9924 is offline  
#16 of 28 Old 04-14-2004, 11:54 AM
 
Tanibani's Avatar
 
Join Date: Nov 2002
Location: Southern California
Posts: 3,052
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
From Misconceptions:

Quote:
In a hospital, underpaid and harried nurses and other staff (likely to include, if you are a low-income woman of color, doctors in training who are using your case to gain experience ) coming in and out of the labor room at will, check you, change shifts, leave and are replaced by others. The Farm midwives, in contrast, often assign three female supportersto each laboring woman.
You are right Keysmama, and you can also see examples of that if you watch "Maternity Ward." Absolutely horrible!

But I think they are done for two different reasons:
1. poor women - to give residents experience
2. women with insurance - because they can do whatever they please AND be reimbursed for it EDITED TO ADD: and liability reasons... they don't want to be sued IF there was a defect that could have been detected.

10 - boy
5.5 - girl
Tanibani is offline  
#17 of 28 Old 04-14-2004, 02:18 PM
 
Piglet68's Avatar
 
Join Date: Apr 2002
Location: Vancouver Island, Canada
Posts: 11,097
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My albeit limited experience with teaching hospitals is not the same as that reported here.

First, I chose to give birth at a teaching hospital in Boston b/c it was affiliated with Harvard, for one thing. And also b/c they were the most BFing friendly hospital I could find. Teaching hospitals, IME, tend to be more educated on the newer issues, like the importance of rooming-in, early bonding with baby (even for C/S) etc. I had many students coming in to check on me during my recovery, and I didn't mind a bit.

My friend gave birth here at the hospital where I work, also a teaching hospital. She had the best insurance (she worked here, too) and still had students and residents coming in. However, she and all the other patients here, had the right to refuse that at any time. She, and I, were always asked if we minded them coming in.

They do an admirable job here of promoting BFing, rooming in, etc in a town where almost nobody BFs and attitudes are quite backwards (lots of PG women smoking, etc.). I think it is because they are a teaching hospital.

teapot2.GIF Homeschooling, Homesteading Mama to DD ('02) and DS ('04)  ribbonjigsaw.gif blogging.jpg homeschool.gif

Piglet68 is offline  
#18 of 28 Old 04-14-2004, 02:57 PM
 
Greaseball's Avatar
 
Join Date: Feb 2002
Location: Eugene, OR
Posts: 8,764
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 2 Post(s)
Quote:
My friend gave birth here at the hospital where I work, also a teaching hospital. She had the best insurance (she worked here, too) and still had students and residents coming in. However, she and all the other patients here, had the right to refuse that at any time. She, and I, were always asked if we minded them coming in.
Are patients allowed to refuse the residents when they don't have insurance?

I've read that in many teaching hospitals, it's not the case. Uninsured or publicly insured patients' babies are delivered by residents, and private patients' babies are delivered by OBs. Maybe things have changed now.
Greaseball is offline  
#19 of 28 Old 04-14-2004, 04:05 PM
 
lena_girl's Avatar
 
Join Date: Mar 2004
Location: Western New York
Posts: 651
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I have found all this to be very interesting, and I thought Id throw in a different perspective. My husband is military so the military provides our healthcare. In different circumstances that care is provided at either a military hospital, or thru a civilian who has aggreed to accept the military healthcare and all it's headaches. I have found a huge difference between what happens at a military hospital and a civilian one in my pregnancies (I am in my 2nd)

Military hospitals are much more interested in cutting any and all cost possible. That means interventions seem to be much less. Military healthcare won't even pay for an ultrasound unless extremely neccessary. (Iwas in premature labor @ 26 weeks and never given one, but as soon as my care was transferrred to a civilian maternal fetal specialist one was done right away)

All of my care in this pregnancy has been civilian since I live too far away from a military hospital. There seems to be so much more they offer to you. More test and whatever (which I usually turn down). It really makes me wonder if they offer all these "interventions" for a healthy pregnancy or to make more money from my care?

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.
lena_girl is offline  
#20 of 28 Old 04-14-2004, 04:22 PM
 
Greaseball's Avatar
 
Join Date: Feb 2002
Location: Eugene, OR
Posts: 8,764
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 2 Post(s)
That's funny...someone else on this board says her military insurance pays for boob jobs and liposuction!

Maybe the military thinks that if the men know they can come home to a good-looking wife, they will be less likely to die in war!:LOL
Greaseball is offline  
#21 of 28 Old 04-14-2004, 04:26 PM
 
Piglet68's Avatar
 
Join Date: Apr 2002
Location: Vancouver Island, Canada
Posts: 11,097
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
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.

teapot2.GIF Homeschooling, Homesteading Mama to DD ('02) and DS ('04)  ribbonjigsaw.gif blogging.jpg homeschool.gif

Piglet68 is offline  
#22 of 28 Old 04-14-2004, 04:39 PM
 
Tanibani's Avatar
 
Join Date: Nov 2002
Location: Southern California
Posts: 3,052
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
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...

10 - boy
5.5 - girl
Tanibani is offline  
#23 of 28 Old 04-15-2004, 12:31 AM
 
FSUBecca's Avatar
 
Join Date: Feb 2003
Location: Iowa City, IA - soon to be JAX FLA!
Posts: 94
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
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?
FSUBecca is offline  
#24 of 28 Old 04-15-2004, 12:45 AM
 
FSUBecca's Avatar
 
Join Date: Feb 2003
Location: Iowa City, IA - soon to be JAX FLA!
Posts: 94
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
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 :
FSUBecca is offline  
#25 of 28 Old 04-15-2004, 10:15 AM - Thread Starter
 
wombat's Avatar
 
Join Date: Nov 2002
Posts: 2,998
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
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!!!
wombat is offline  
#26 of 28 Old 04-15-2004, 04:44 PM
 
lena_girl's Avatar
 
Join Date: Mar 2004
Location: Western New York
Posts: 651
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
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.
lena_girl is offline  
#27 of 28 Old 04-15-2004, 04:48 PM
 
Greaseball's Avatar
 
Join Date: Feb 2002
Location: Eugene, OR
Posts: 8,764
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 2 Post(s)
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.
Greaseball is offline  
#28 of 28 Old 04-15-2004, 05:16 PM - Thread Starter
 
wombat's Avatar
 
Join Date: Nov 2002
Posts: 2,998
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
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.
wombat is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off