THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Wednesday, January 17, 1996 TAG: 9601170002
SECTION: FRONT PAGE: A8 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 51 lines
For several years now, health-insurance companies have been ordering women and their newborns out of the hospital shortly after delivery - typically within 24 hours for an uncomplicated vaginal birth.
It's a disturbing trend. Not because there's any need to go back to the days when women spent a week or more in the hospital after delivery. But because an insurance company shouldn't be the one telling a woman when she is ready to go home. It should be between her and her doctor.
This is an issue that reaches beyond the maternity ward. As managed care becomes the insurer of choice - or only resort - for more and more people, restrictions on what, when and where health care is provided also increase.
So in addition to a visit from your doctor to check on that pneumonia, you may also receive a visit from an HMO nurse. She could be the one writing on your chart that you're ready to go home tomorrow. If your doctor agrees, great. If not, he or she will have to argue the case with the HMO, more than likely losing.
It's not like your doctor will earn more money if you stay in the hospital. These days, HMOs typically pay physicians a global fee for most procedures. So in the case of maternity care, for instance, doctors get a lump sum to cover pre-natal, delivery and post-partum care, regardless of how often they examine you or what complications may develop.
In the past, when mothers of newborns had extended family at home to help after a hospital stay, these ``drive-through deliveries,'' as some call them, might have been OK. But today, with families disbursed around the country and with more single mothers having babies, that option often doesn't exist.
Four states have already passed legislation requiring that insurers pay for at least a 48-hour hospital stay if the physician or the mother requests it. This is an important distinction. As a writer in the Dec. 14 issue of The New England Journal of Medicine points out, ``The provision that women themselves make the final decision represents a legislative determination that their obstetricians and pediatricians cannot exercise appropriate medical judgment when under intense pressure to contain costs.''
Now Virginia Del. Clifton A. ``Chip'' Woodrum has proposed similar legislation in Virginia. We hope it can survive the tough insurance-company lobby. And we hope its message - that most medical decisions should be made by the doctor and the patient, not the insurance company - is heeded in the future. by CNB