Sunday, March 01, 2009

Consider Heathcare Costs - Women's reproductive health the cost of various treatments and interventions

As the new Obama administration begin to take on trying to overhaul our health care system, it has brought to mind a few things that I thought I would share.

In reading the second volume of the Eleanor Roosevelt biography I was surprised to read how the United States had seriously considered implementing a national health care program but that it failed to get enough support. Whoa! Isn't that the same old tune we keep hearing.

At any rate, in light of my recent adventures in reproductive health and fertility I see the opportunity for savings. Here's how...

Fibroid interventions -- most American women seem to be offered hysterectomy as the ideal treatment for uterine fibroids. Regardless of whether the procedure is done with abdominal surgery or trans-vaginally, this is a major surgical procedure involving hospital stay, and with its inherent post-operative risks of infection, etc. Also, hysterectomy can be associated with physical changes which can lead to ongoing treatment with medication for pain, sexual side effects and more. Since most women have discussions solely with their ob/gyn about their fibroid related symptoms, and since ob/gyns are trained in hysterectomy that is what is offered. Yet, fibroid embolization is an appropriate treatment for women who are finished having families.

Abdominal myomectomy is the current standard of care for women wanted to preserve their fertility, and it costs are comparable, if not a little higher, to the cost of an abdominal hysterectomy (due to the longer length of the procedure as I understand it). Again, fibroid embolization (UFE, UAE) might also be appropriate for younger women as well -- further studies are needed to determine its affects on fertility post procedure. Also, I'm interested to see what ongoing screening and increased understanding of hormonal imbalances contributing to fibroid growth might uncover in the way of reducing the formation of more troublesome fibroid related symptoms.

Obstetrical care in the U.S. is a huge expense -- I saw mention that it might be a 5th of total health care costs -- and yet it isn't even a part of the discussion how unnecessary interventions and liability-based delivery management practices are driving costs much, much higher.

Check out some links on the subject:

Commentary in response to New York Times' November 25th Editorial on the High Cost of Health Care
Faith Gibson ~ December 31, 2007

How Childbirth Went Industrial: A Deconstruction -

Management of Suspected Fetal Macrosomia
Macrosomia is the medical term for a big baby -- noted in this article as "arbitrarily defined" at 8 lb, 13 oz. (4,000 g)
A recent decision analysis estimated that to prevent one case of permanent brachial plexus injury, 3,700 women with an estimated fetal weight of 4,500 g would need to have an elective cesarean section for suspected macrosomia at a cost of $8.7 million per case prevented.

Revealing the Real Risks: Obstetrical Interventions and Maternal Mortality
By Marsden Wagner - Issue 118, May/June 2003

A Guide to Effective Care in Pregnancy and Childbirth - Synopsis
This page links to interventions grouped as:
(1) beneficial forms of care;
(2) forms of care that are likely to be beneficial;
(3) forms of care with a trade-off between beneficial and adverse effects;
(4) forms of care of unknown effectiveness;
(5) forms of care that are unlikely to be beneficial;
(6) forms of care that are likely to be ineffective or harmful.

An Interview With Ina May Gaskin
by Stacy Fine - Web Interview - June 29, 2007
Both maternal and infant mortality are currently rising in the US. Maternal death rates have not improved, according to the Centers for Disease Control, since 1982. That's a long time to have had no progress, despite all of the technological innovations that have taken place since then. Part of the problem in this sector is that the US has never created a system of accurate reporting of the data necessary to find out what mistakes we might be making so that we can analyze them and then make policy that reduces the likelihood of mistakes being repeated. The United Kingdom (England, Scotland, Wales, and Northern Ireland) have had such a system in place since 1952, which is probably why their maternal death rate is significantly lower than ours in the US. I don't know of any European country in which maternal death classification is done according to an honor system, but that is exactly what is done in almost every US state. There is no audit, and autopsies are less likely to be performed here than in European countries.

Confidential Enquiry into Maternal and Child Health (CEMACH) commenced in April 2003. We aim to improve the health of mothers, babies and children by carrying out confidential enquiries on a nationwide basis and by widely disseminating our findings and recommendations.