Medi-Cal Fees to Obstetricians

As an obstetrician who has been providing services to Medi-Cal patients for over 20 years in San Diego, I too commend The Times editorial “Next Generation at Risk” (Nov. 10).

However, Lori S. Harrison’s letter (Nov. 17) applauding the New Comprehensive Perinatal State Program is a joke. The facts remain as follows: In 1985 the state reimbursed an obstetrician $457 global fee for taking care of a woman from day of pregnancy through delivery and post-natal care. In 1986 the state review board realized the fee was inadequate and revised the fee to $657 for the same total OB care.

As of October, the state now has said if an obstetrician doesn’t take care of this patient 100 days prior to delivery, it will pay a delivery fee of $328.64. Unfortunately, most Medi-Cal patients don’t make their first appointment with their doctor until they are five or six months pregnant--due to their perceived difficulties in obtaining Medi-Cal.

These patients are the most high-risk and litigious patients to care for. As a result of this, most obstetricians find that it is not cost-effective to provide care for this group of very high-risk patients due to the exorbitant expense for their malpractice coverage.

The fact remains that due to “no-care patients,” the state spends 10 times more for its care because of intensive-care nursery costs than if it paid a decent fee for comprehensive prenatal care.

The solution to this problem seems to be obvious--by paying the provider a reasonable fee and educating the patients to early prenatal care, everyone will benefit because the result will be greatly reduced costs to the taxpayers.

DONALD G. BYRNES, M.D.

San Diego