Making a Difference : One profession’s approach: A model for low-income health care : A public/private partnership averts a deadly crisis in prenatal care.

Los Angeles County is the most medically underserved metropolitan area in the United States, according to a report of the Task Force for Health Care Access, appointed by the Los Angles County Board of Supervisors. A threefold increase in county services or contributions from private doctors, clinics, and hospitals is necessary to meet the basic health needs of its residents the task force estimated. One report recommendation was to establish greater cooperation between public and private health sectors.

An example of a successful joint effort already exists. When county demand for obstetrical services among indigent women skyrocketed in the 1980s, exceeding county capacity by hundreds of births each month, health care professionals joined together to forge a two-pronged OB Access program:

--The Pre-natal and OB Access Project of the National Health Foundation helps identify women who need pregnancy care and refers those eligible into county health care programs;

--The Contract Program Office (CPO) of the county’s Department of Health Services pairs eligible patients with private obstetricians and hospitals who have agreed to provide services to Medi-Cal patients.

The programs have increased the supply of obstetrical services and its ability to provide prenatal, delivery and post-partum care to poor women.

Then and Now

1988-89: A Crisis Explodes

Demand for obstetrical care by low income women in L.A. County exceeds capacity by more than 4,000 births a year.

Medi-Cal eligibility problems and payment delays or non-payment plague the system and discourage physician participation in contract programs. Availability of obstetricians is also limited by high malpractice insurance rates.

1990-91: A Solution Emerges

Dr. David Chernof, past president of Los Angeles County Medical Assn, creates and chairs the association’s Task Force on OB Access, bringing together members who represent needed specialties.

The county develops specific system changes and plans for a greatly enlarged contract program.

Grant money is sought for prenatal clinics that enhance the county-funded program.

1991-92: OB Access in Operation

The county contracts with private obstetricians/gynecologists and hospitals to provide pre-natal, delivery and post-partum care for routine pregnancies in participating private hospitals.

Seed money from private foundations is used to establish pregnancy care clinics at private hospitals and provide community outreach to indigent women.

Payment is provided to physicians and hospitals for services at Medi-Cal rates within 30 days of service. Continuity of services is assured with county-provided malpractice insurance.

RESULTS:

Annual county childbirth capacity for indigent women.

1988-89 / 41,765

1992-93 / 58,884

Number of Contract OB/GYN physicians

1988-89 / 0

1992-93 / 139

Number of Contract Hospitals

1988-89 / 26

1992-93 / 38

Number of Prenatal Clinics

1988-89 / 7

1992-93 / 17

County infant Death Rate per 1,000 live births

1988 / 9.2

1989 / 9.2

1990 / 8.0

1991 / 7.8*

* provisional estimate

Sources: Los Angeles County Department of Health Services, Contract Program Office and Data Collection Office; State Department of Health Services.

“The bottom line is that there now exists--because of this public/private partnership between doctors, hospitals and the county--a capacity that will more than adequately meet the needs of the county. The patients are getting care, getting prenatal care earlier, and they know that the county will provide or get them care.”

--Maureen Williams, director, Contract Program Office, County Department of Health Services

PARTNERS IN THE OB ACCESS PROGRAMS

American Academy of Pediatrics--Los Angeles Chapter

American College of Obstetricians and Gynecologists--Los Angeles Chapter

California Pediatrics Society

Hospital Council of Southern California

Los Angeles County Department of Health Services

Los Angeles County Medical Assn.

Los Angeles Obstetrics and Gynecology Society

March of Dimes

National Health Foundation

Rand Corporation

Southern California Health Policy Research Consortium