Editor's Corner

Health Care Finance

by Michael E. Speer, MD
Professor of Pediatrics-Neonatology
Baylor College of Medicine

Neonatology has made incredible advances over the 50 years that the Newborn Section at Baylor College of Medicine has been in existence. Thousands of neonates have benefited from new technologies, medications, and medical and surgical advances.

Although survival has increased and morbidities decreased, an ever-present number of children have chronic conditions such as hydrocephalus, chronic lung disease (ie, BPD), chronic renal failure, and nutritional fragility caused by short-gut syndrome. Not only do these children require extra ordinary care during their hospitalization but also after discharge.

In fact, the need for complex home care has increased as insurers and families have pushed for earlier hospital discharge. The ultimate costs for these in- and out-patient services are large, both in human and monetary terms. Unfortunately, reimbursement for post hospitalization care of these infants is grossly inadequate.

State Medicaid reimbursement, for example, is less than that of Federal Medicare, which, in turn, is considered insufficient by many in the health care field. This lack of funding, particularly by the states, often leads to a lack of accessible, appropriate medical care. Clinics, private medical offices, or hospital outpatient departments must close if reimbursement is less than the cost of providing care. Difficult access to medical care is compounded by delays in obtaining appropriate care because increasing numbers of physicians are declining to participate in Medicaid.

We who care for the fetus and newborn must contact and convince our legislators of the fiscal soundness of a policy that appropriately supports the timely care of our small patients, as opposed to more expensive care that becomes necessary when needed health care is neither accessible nor available.