Posted by on November 6, 2012 - 11:23am

While the country struggles to provide affordable, quality health care to all Americans, a primary focus has been on women and children. However, one group of care providers is rarely discussed by health policymakers despite their significant contributions to health care: Midwives.

Certified nurse-midwives (CNMs) and certified midwives (CMs) provide high quality primary and maternity care to women and families. CNMs are recognized under federal law as primary care providers for women. They provide family planning services, gynecology services, primary care, childbirth and postpartum care, care of children for the first 28 days of life, and treatment of male partners for sexually transmitted infections. Midwives also use their credentials to prescribe medication, admit, manage and discharge patients, and interpret laboratory and diagnostic tests. These skills allow midwives to offset many of the primary and maternal care functions of MDs, and do so with lower costs.

The Institute of Medicine published in its report The Future of Nursing that critical workforce shortages are being seen across all health care systems, especially in primary and maternity care. There is a vast amount of literature that suggests CNM and CM professionals provide a high-value, cost-effective, patient-centered form of care in exactly those arenas. As 2014 and greater implementation of the Affordable Care Act nears, access to midwives is ever increasing, with the Affordable Care Act granting midwives 100% reimbursement under Medicare Part B. Further, new nondiscrimination requirements have been employed to ensure that individual and group health insurance plans must cover these services for women.

Nevertheless, many stakeholders including clinicians and policymakers are unaware of or fail to discuss the significant role midwives will play in health reform. Nor are they adequately addressing how barriers to their practicing medicine continue to play out in the medical world. It’s about time we make sure all women’s preventative and maternal services are given full attention and made effective.

Posted by on August 24, 2012 - 7:40am

The U.S. can learn from Mexico's recent efforts at health reform, especially as it relates to transferring care from specialists back to primary care physicians, researchers said.

Mexico created its national health insurance program, called the Seguro Popular in 2003, and achieved universal coverage for its 100 million citizens earlier this year, Felicia Knaul, PhD, of Harvard Medical School and colleagues wrote in the Aug. 16, 2012 edition of The Lancet.    The program now provides coverage to 52 million previously uninsured Mexicans, they noted.

Its list of essential covered services grew from 91 in 2004 to 284 in 2012 -- covering treatment for more than 95% of conditions in ambulatory units and hospitals, Knaul and colleagues wrote.  Meanwhile, Mexico also built 15 high-specialty centers, more than 200 hospitals, and almost 2,000 ambulatory clinics.

As the country slowly expanded coverage, its state-run specialty care centers became overcrowded with patients. To avoid facing a similar problem, the U.S. could learn to strengthen primary care's ability to provide follow-up treatment to patients recovering from catastrophic illnesses such as cancer, Knaul said in an interview with MedPage Today.

"That's not what primary care has been able to do well," she said.

The real challenge for the medical community will be how to train primary care doctors to handle that, Knaul said. It's not good for patients to continue to seek treatment at the specialty level, but it can be complex to link that follow-up care back to primary care doctors.

Regardless of how that's done, Mexican reform has shown it's possible to build financially responsible ways to treat chronic diseases alongside prevention, Knaul and colleagues wrote.

"Part of the global community has been convinced that middle-income and especially low-income countries should limit their activities to prevention in the case of chronic and noncommunicable diseases," the paper stated. That line of thinking is wrong and would conflict with the point of health reform, which is to provide affordable healthcare to all citizens, Knaul said.

For example, although treating a chronic illness like childhood asthma isn't expensive from month to month, Knaul pointed out that it adds up over time and can be financially burdensome.

Knaul knows of Mexican families living in the U.S. that have developed serious medical conditions, lost their jobs and their work visas as a result, and have returned to Mexico because they can be treated there. "Hopefully, this will change as a result of reform in the United States," she said.

Health reform in Mexico has spurred economic growth while improving health, Knaul noted. The infant mortality rate dropped from from 18.2 to 14.1 per 1,000 live births from 2000 to 2010. The percentage of deaths from communicable diseases also fell -- from 15.4% to 10.8% -- during the same period.

Meanwhile, the gross domestic product per capita in Mexico increased from $11,852.70 in 2000 to $12,440.90 in 2010.