Tuesday, December 27, 2011
Moving Responsibility from Individuals to Institutions
It seems that with the great improvements in neonatal care, mothers
and obstetricians have been delivering babies earlier and earlier, often as a
matter of convenience rather than for medical reasons. While most of these babies do perfectly well,
a number of them need expensive intensive care and the incidence of
complications is higher than it is for those delivered later.
What struck me was that the decision was being attributed to
hospitals – not to individual physicians, the medical society, the Department
of Health or to the College
of Obstetrics and
Gynecology.
The story also reported that the Texas Medicaid program is
now refusing to pay for induced deliveries and caesarean sections before the 39th
week of gestation unless medically justified.
Consistent with fair journalism, the story included
interviews with mothers who were in opposition, suggesting that the motive was
to save money, complaining that they were being deprived of their rights and
arguing that such decisions ought to be in the hands of patients and their
doctors.
It all reflects the need to get used to the idea that
responsibility for our health care is moving from individuals to institutions.
It may be uncomfortable, but it is inevitable.