I have to admit, I’ve been surprised by the dearth of comments regarding the recent decision by North Hawaii Community Hospital to limit new maternity care to folks living within their defined service area. I have to admit, I’ve been
I have to admit, I’ve been surprised by the dearth of comments regarding the recent decision by North Hawaii Community Hospital to limit new maternity care to folks living within their defined service area.
In case you haven’t noticed, there’s a distinct subset of our island population (the young and willing) that seems intent on making babies — it is, after all, a most natural and affirmative thing to do. And, God willing, is unlikely to change — babies are, after all, the future.
But North Hawaii’s recent decision should be generating, at least, a great deal of discussion — and not at all at the decision (which is a prudent one, made after extensive evaluation, for safety and, yes, realistic financial reasons).
What should be generating concern is the underlying issues that led to this.
It is, frankly, financial reasons that linger in the background of why it is so difficult to recruit and retain obstetricians to the Big Island. On the personnel side, it takes a minimum of 12 years of college, medical school, internship and residency training to become an obstetrician; most of these folks finish their training with in excess of a quarter million dollars in debt. Whether they start a private practice (more mega-debt) or join a medical group, they, or their employer, face a yearly malpractice insurance cost of about $63,000. Add to this the usual problems in seeking and retaining health care workers of all stripes to our island home — the schools, the parks, housing costs, living costs, relative remoteness and, yes, the relatively meager reimbursements. (A new OB seeing a newly pregnant patient may charge a fee for the initial office visit but thereafter any fees for managing that pregnancy are bundled together and not paid — not a penny — until after delivery, generally many months hence. In the meantime, there are bills to pay.) And, too, while they face an immensely rewarding career, it’s a tough life — on call, day and night, yearlong, for babies eager to enter the world at oft-seemingly inconvenient times.
On the hospital side, there are also gigantic financial issues: Most babies join the human race at times of their own choosing, on their own unpredictable schedule; but the hospital has to be ready to assist with their arrival at any time, every minute of every day throughout the year. This means full staffing 24/7, whether any babies choose to take the plunge on any one day or not. Like emergency rooms, and unlike elective surgery units, OB departments cannot shut down on holidays, weekends — not, indeed, anytime.
While most women have healthy pregnancies and experience a normal birth, problems can develop and this is why a full-fledged obstetrics program must be available and ready at all institutions.
This costs lots of money: Together, the three acute care hospitals on the island lose up to several millions of dollars per year maintaining this 24/7 availability — their costs are fixed, in terms of staffing and facility readiness, whether any babies come that day or not.
The sorry fact is the various insurers simply do not reimburse practitioners or hospitals commensurate with the costs of maintaining these services: Each of Hilo, Kona and North Hawaii hospitals lose, on average, in excess of $3,000 on each delivery. Try that in any other business and see how long you stay afloat.
So, what can you do to help? As expectant mothers, husbands or lovers of mothers, aunts, uncles, grandparents or neighbors — in short, as Big Island residents, get educated on the issues and get involved:
• Plan your pregnancy — not always possible, but worth a try
• Plan what you’re going to do once you’re pregnant — who are you going to see for your prenatal needs? Where’s the office?
• Stop smoking. And babies don’t like alcohol, either.
• Eat well — you’re eating for two now (maybe three).
• Get involved — go to community meetings where health care is discussed and make your needs and concerns known
• Contact your state legislators and insist that they restructure Medicaid and private insurance payments so that hospitals and practitioners are fairly reimbursed: Hospitals losing $3,000 on each birth simply cannot conceivably support the continued investment needed to maintain state-of-the-art maternity services.
• Any discussion of maternal care must recognize the fundamental roles of both obstetricians and midwives during pregnancy, delivery and the postpartum period. In some communities, the role of midwives is more integrated than in others. This, too, is properly a matter for more discussion.
The bottom line is this: Access to quality maternity care is not a North Hawaii problem, not a Kona problem, or a Hilo problem — it’s a Big Island problem. Ensuring that expectant mothers receive the best in care throughout their pregnancies is an issue for all of us — the oncoming generation is, in fact and reality, the future of our island home. Let’s do well by them.
Ali Bairos is a surgeon from Kealakekua.
