Debating overtreatment or prevention in pregnancy
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Tess Vigeland: So as Ben Franklin knew, when it comes to health, the more we know, the more we tend to buy. Or at least the more someone tries to sell us. And that’s true today.
So we thought we’d hear about the experience of navigating the system from the ultimate informed patient. Here’s WHYY’s Kerry Grens.
Kerry Grens: I have been a health reporter for six years, but I’ve never walked into a hospital without a microphone. And in fact, I’d never really been a patient until I started coming in with something doctors and insurance companies code as V 22.0.
Also known as pregnancy. Now, as I sit here, out of breath from my peanut-size lungs and my watermelon-size belly, I’m a regular.
Midwife: So where is this kid kicking you mostly?
Grens: I feel the hiccups slow down, and then I feel the baby usually over on this side more?
I’ve had 12 check ups, had my blood drawn, made two trips to the hospital for screening tests, and I’ve peed in a cup a lot. Although I’ve interviewed people about their struggles with co-pays and getting procedures denied, my insurance paid everything but $20.
Rob Field: From the insurance company’s perspective, they want to encourage you to get the prenatal visits because the payoff to them is huge: the difference between having a healthy baby and an unhealthy baby.
That’s Rob Field. He’s a health care regulation expert at Drexel Law School. Obviously, preventing problems is cheaper than treating them after the fact. But insurers have another incentive to treat me well.
Field: Insurance companies love having young healthy women about to give birth. It’s their perfect demographic. They then get a healthy young family who are likely not to run up the bill.
After all the stories I’ve written about the downsides of screening tests — the false alarms, the uneccesary interventions — I didn’t even want one ultrasound.
Vincenzo Berghella: If you detect it early, for example a heart defect or other defects, it has been shown that the preparations you’re going to make before delivery are going to improve the outcome.
Leave it to Vincenzo Berghella, the head of fetal and maternal medicine at Thomas Jefferson University to knock me back into ‘what if’ mode. Even though very few babies have a defect, could I live with myself if I chose to skip this scan just to avoid a false alarm? So I got it.
Bob Grens: Cigarette smoking. Probably not a good idea. Caffeine. Sugar substitutes. Sugar substitutes?
My husband Bob and I have been reading through a stack of popular pregnancy books — full of warnings.
Bob Grens: Sports, hot tubs, microwave exposure.
The problem with these warnings is that they don’t put anything into context. How long do I have stand in front of a microwave for it to hurt my baby?
I’ve been operating under the assumption that pregnancy is a healthy condition — and so I decided from the beginning that I didn’t need to see a doctor.
Nicole Black: Midwives, we’re trained in the normal natural process. Versus obstetricians are trained surgeons.
Nicole Black is a certified nurse midwife at a birth center in Wilmington, Del.
Black: And so I think sometimes you rise to the level of what your training is. And so it’s like, O.K., there’s something going on here, it might be easier to do a cesarian. Versus midwives, we don’t necessarily have those skills, there’s not something in our skillset, so we don’t necessarily go to that right away.
Black’s not my midwife, but she was my inspiration. I had interviewed her last year about out-of-hospital births, and liked the idea. But it’s just like with the ultrasound: even though it’s highly unlikely that something would go wrong, I couldn’t let go of the security of an operating room and an intensive care unit down the hall. And so I found a compromise: the midwives I see deliver babies at a hospital. For now I can entertain myself by thinking about baby names and breast-feeding, and not about being sick.
And that’s what makes pregnancy different from everything we lump under health care and pay for with insurance. As Rob Field at Drexel points out, it’s not a disease.
Field: I think pregnancy does stand out in that regard as being something very positive that you get someone else to pay for. How often does that happen in life?
For this reporter, at least once. I’m Kerry Grens for Marketplace Money.
Vigeland: And Kerry’s 6-pound, 11-ounce baby Henry Paul has since arrived.
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