Health Care Anew

Moving Responsibility from Individuals to Institutions

 Listening to the radio while driving home from a shopping trip yesterday afternoon, I was much taken by a story about how hospitals in Massachusetts are refusing to allow elective inductions of obstetrical labor or caesarean sections before the 39^th week of pregnancy.

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 39^th 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.