Starting Off on the Wrong Foot : Innovative obstetrics payment program in L. A. fights overwhelming tide

Many babies die because their mothers received no prenatal care. The latest statistics on infant mortality rank the United States 21st in the world. That puts this nation in the same shameful league with some poor Third World nations.

Too many babies are suffering birth defects, chronic problems and disabling conditions that in at least a quarter of the cases, according to federal health experts, could have been prevented if their mothers had received adequate medical attention.

Prenatal care, however, has become something of a luxury in Los Angeles. The wait for an appointment can take months at an overcrowded county clinic. The long overburdened public health-care system is now bursting at the seams.

More money is certainly part of the cure. A single dollar spent on regular prenatal checkups and other related maternity care can eliminate $3 worth of high-tech care after the baby is born, according to health experts. But government alone cannot handle the crisis.

Dangerous overcrowding exists at public hospitals, while many private hospitals have empty ob/gyn beds. Too often, a poor or uninsured expectant mother never sees a doctor until she shows up in labor in an emergency room.

As many as 60,000 poor or uninsured women are expected to deliver babies in a county system that has an annual capacity for 35,000. That explosion in births calls for the redesignation of medical and surgical beds to maternity beds, fuller funding for Medi-Cal and more employers providing health insurance. As the problem worsens, private hospitals and physicians must also shoulder more of the burden.

Thankfully, an innovative plan will encourage greater participation by the private sector. A mammoth effort by county health officials, the state and private hospitals has encouraged more hospitals, more than two dozen so far, to treat more uninsured and poor women.

In exchange, the county will eliminate the red tape that hobbles the Medi-Cal program and make timely, direct payments to the participating hospitals.

Private physicians, who often shun Medi-Cal patients because of the deluge of paperwork, notoriously slow payment and denial of claims, would also get timely compensation.

This experimental plan is scarcely a cure-all, but it will allow as many as 300 additional mothers per month to get prenatal care and give their babies a healthier start.