Team Effort Relieves Crisis in Obstetrics : Alliance of Agencies Helped Upgrade Medical Services

After facing a crisis situation just two years ago, Orange County has improved dramatically its obstetric and prenatal services for poor pregnant women. There still is much to be done, but more women are getting care during pregnancy and finding a facility for delivery when they reach term.

Part of the credit for this change can go to the state of California, which improved its reimbursement rates and made an important change in Medi-Cal eligibility rules. Improved cooperation of county agencies also helped. But the county’s medical and social services community, which organized to address the crisis forcefully, is especially deserving of praise.

Among the most important results was funding for two birthing centers to provide cheaper deliveries for low-risk births. Orange County’s Health Care Agency provided $2.3 million in state cigarette tax money for the centers at UCI Medical Center in Orange, which opened a year ago, and Western Medical Center-Anaheim, which will open soon.

But that’s just the beginning. Several nonprofit clinics have added obstetrical services. There is a new mobile prenatal clinic operating out of St. Jude Medical Center in Fullerton. And coming at the end of this year is MOMS--the Maternal Outreach Management System--a nonprofit agency that will help poor expectant mothers apply for Medi-Cal and then link them up with physicians and hospitals. MOMS, a good example of a public-private partnership, also will help pregnant women with transportation, child care and other problems that prevent them from seeing a physician.

As an indication of how things have improved, two years ago 30% of the women who came to UCI Medical Center’s emergency room to deliver babies had not seen a doctor; now only 5%-7% have not. That means that thousands of babies are getting a healthier start. It also controls costs because premature or other problem births are expensive. Studies show that every tax dollar spent on prenatal care saves many.

Serious problems in Orange County’s maternity services for the poor first came to light in June, 1990. UCI Medical Center, saying it was overburdened with low-income patients, posted security guards in its parking lot to try to turn away women who already had gone into labor. The community was jolted into action. A perinatal task force was formed to bring together those concerned--among them county officials, volunteers, physicians and hospital administrators. MOMS was one upshot. Another was increased cooperation of the medical community in providing obstetrical services.

It was good fortune that around the same time the state changed its Medi-Cal rules to allow undocumented women about to deliver babies--infants who would become citizens at birth--to be eligible for Medi-Cal. There also was a long overdue adjustment in reimbursement rates for their physicians. In addition, the state, concerned about the level of care in Orange County, boosted rates to hospitals that had obstetric contracts with Medi-Cal, which increased the number of hospitals offering services. At the same time, the county’s skyrocketing birth rate leveled off.

The crisis eased.

Whether that is temporary depends on many factors. For example, there remains a pressing need for more physicians to accept Medi-Cal patients. And a reduction in Medi-Cal reimbursement rates could return the county to the bad old days.

Still, Orange County and its medical and social services community have forged a remarkable alliance that should help avoid another obstetrical crisis in the future.