Lack of health insurance drives many people to under- and over-utilize health services in ways that are costly to taxpayers and damaging to their long-term health. The ranks of the uninsured are swelling each day, and we can expect the human and financial costs of inadequate preventive and primary care to rise in proportion. Recent local reports have highlighted a classic example: our health financing system's shortsighted investment in acute care over preventive care.
This newspaper's recent call for expanding coverage for women who have had a poor pregnancy outcome does not go far enough. It focuses on intervening after the problem has manifested - too much in line with the flawed policy approach that has gotten us to where we are today.
The Baltimore Health Department reports that in 2007, Baltimore's overall rate for low-birthweight babies was 12.8 percent, and in Maryland the rate was 9.1 percent. At Baltimore Medical System, we delivered 1,497 babies last year; only 8.15 percent had low birthweights. Yet our patients represent all the highest-risk categories: the working poor, the newly immigrated, people living in long-term poverty and the unemployed.
A well-thought-out prescription for healthy babies would be comprehensive and truly preventive in its approach. It would include preventive care for all low-income families, including women before they become pregnant (and not forgetting fathers, who are marginalized by benefits that focus only on women). That system should be designed with incentives at the primary care level - the least costly and most holistic link in our fragmented health system. Such a system needs to embrace new immigrants as well, many of whom are not eligible for coverage within the current system until their date of delivery under an "emergency Medicaid" provision. There is no better way to make a birth an emergency, with all the ensuing negative consequences for the family and for society, than to not provide coverage until the date of delivery. And the cost of one day in a neonatal intensive care unit is more than the cost of providing care for the whole prenatal period.
How is a community health provider to keep meeting this growing need with grants that remain fixed at a static level and with limited space? The health care financing system puts us at risk at every step, with inadequate reimbursement of our basic health services and inadequate capital investment in our facilities.
It doesn't take a pilot study to show that if you give women access to comprehensive, accessible, affordable and culturally competent care, you can cut down on low birthweights and reduce all the attendant economic and human costs. What we need is health care reform, putting the money where the problem and the solution both lie - in community-based primary and preventive care. Anything less than a comprehensive approach toward prenatal services risks throwing good money after bad.