Newborn mortality rate - social causes?

[livendive 8]

According to this article, the US has the second worst newborn mortality rate in the industrialized world, second only to Latvia and tied with Slovakia, Hungary, Malta, and Poland. My perception is that we have a pretty high-tech infant healthcare infrastructure, and the article kind of bears that out while listing the economic and racial correllations. Anyone interested in discussing the social causes or suggesting viable improvements?

Blues,
Dave

"I AM A PROFESSIONAL EXTREME ATHLETE!"
(drink Mountain Dew)

[Andy9o8 2]

I note the article says - among other things :

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Japan was among a number of nations highly ranked [i.e., high infant survival rate] mainly because they offer free health services for pregnant women and babies, while the United States suffers from disparities in access to health care.

This actually may say a lot. The US has excellent health care, better than maybe 90% of the other industrialized countries at the highest levels of care - but the flip side is that just about all the industrialized countries except the US have some form or another of universal health care, whereas in the US, you have health care if you're employed, but if you're unemployed (unless you're on welfare), under-employed or self-employed, there's a pretty fair likelihood that you don't have adequate health insurance, if any at all. So yeah, on the one hand, the US doesn't have the chronic mediocrities in their health care system that exist in "socialized medicine" national health service countries like the UK and Canada, but on the other hand, there are also more people in the US who have NO access to health care - and many of them are not impoverished - mainly because they don't have "traditional" employment and can't afford the monthly premiums for private health insurance. So my semi-educated speculation is that, in the midst of all this plenty, the lack of a universal health care/insurance system in the US is at least part of the reason for its shameful infant mortality rate. Not the only factor, but a significant one.

[lawrocket 3]

Having worked in a county hospital with primarily high-risk OB pregnancies, I've got some of my own anecdotal knowledge.

One of the big problems we have is the general health of these mothers. Many, especially in the minority communities, are not very healthy individuals. Furthermore, this lack of good health is compounded by the general lack of health care. It's not nevessarily that the health care isn't available. It's more often a matter of choice not to get prenatal care or not to follow medical advice with regard to the health.

There are also a lot of societal ills that befall us. A fairly prevalent cause of low birth weight babies is drug abuse. Coupled with the lack of prenatal care and the otherwise poor health of many of our poorest (and even middle class in society) and you have the makings for an increased infant mortality.

Once these babies are born, without having had any prenatal care, there is often little that doctors can do to help them.

My wife is hotter than your wife.

[lawrocket 3]

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The US has excellent health care, better than maybe 90% of the other industrialized countries at the highest levels of care - but the flip side is that just about all the industrialized countries except the US have some form or another of universal health care, whereas in the US, you have health care if you're employed, but if you're unemployed (unless you're on welfare), under-employed or self-employed, there's a pretty fair likelihood that you don't have adequate health insurance, if any at all.

My experience is that everyone has access to medical care.

But, assuming what you say is true, what does that say about a society whose thought process is, "If someone else won't pay for it, then screw health care."

My wife is hotter than your wife.

[wmw999 2,556]

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everyone has access to medical care

What kind of access? Preventive health care as a normal thing? Or do they make it a major pain in the ass if you're poor? Trust me, it's generally the second, unless you're close to a free clinic.

Health care should be a normal part of people's lives. It's not, for both financial and personal responsibility reasons. But, well, if you had to choose between expensive health care that had no definable and definite benefit (after all, most babies are OK), and food, housing, transportation, or entertainment, well, many of us choose the second curtain.

How many skydivers have regular physicals? How many put off health care for injured joints because they want to keep jumping?

Wendy W.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[lawrocket 3]

Therein lies the problem. Don't have health insurance? Well, you can get it. Need to see a doctor for that yearly physical but dont' have insurance? Cough up a couple hundred bucks for it.

Heck, apply for life insurance! They'll give you a physical! I've had two physicals in two years from life and disability insurance physicals. They paid for it.

Access is not easy for the poor. In a sense, you get what you pay for. Free care is rationed, just like any other form of subsidized care. It means that you have to wait. The choice is paying 65 bucks in cash for an office visit.

That prenatal care you need? Pregnancy test? Check. $15. AFP screening? State pays for it. Other blood screenings? The state pays for most. It's actually a eugenics program to identify genetic anomalies and attempt to control them.

Ultrasound? Not necessary unless a high or low AFP result, and if that's the case, the state will usually pay for the scan. (The AFP results are off the vast majority of the tme because of poor date calculations by the mother). Well-checks coming up? It's cheaper for the state to cover those prenatal visits than it is to cover a sick mother and/or baby after delivery.

We've got the State of California ADVERTISING the benefits it provides. It's a pain in the ass to go to the doctor. True. It means you have to make a hole of a couple of hours in your schedule.

Too many put it off, and put it off, and put it off, until labor comes along. Oops! Well, then they gotta get to the hospital, and only then is the placenta previa diagosed. Maybe far into labor. That kid with trisomy 18 that could have been identified earlier is not identified. The list goes on.

Having worked in an LA County clinic dealing with high risk OB, I got a sense of it. And, truth be told, there are cultural differences. Much of America is a third-world mentality, which is expected when you have a large portion of immigrants from the thrid-world.

The access is there. It's being advertised. But the ER is there for when help is REALLY needed. By then, it is an emergency. And then it may be too late.

My wife is hotter than your wife.

[penniless 0]

Quote

Therein lies the problem. Don't have health insurance? Well, you can get it. Need to see a doctor for that yearly physical but dont' have insurance? Cough up a couple hundred bucks for it.

Heck, apply for life insurance! They'll give you a physical! I've had two physicals in two years from life and disability insurance physicals. They paid for it.

Access is not easy for the poor. In a sense, you get what you pay for. Free care is rationed, just like any other form of subsidized care. It means that you have to wait. The choice is paying 65 bucks in cash for an office visit.

That prenatal care you need? Pregnancy test? Check. $15. AFP screening? State pays for it. Other blood screenings? The state pays for most. It's actually a eugenics program to identify genetic anomalies and attempt to control them.

Ultrasound? Not necessary unless a high or low AFP result, and if that's the case, the state will usually pay for the scan. (The AFP results are off the vast majority of the tme because of poor date calculations by the mother). Well-checks coming up? It's cheaper for the state to cover those prenatal visits than it is to cover a sick mother and/or baby after delivery.

We've got the State of California ADVERTISING the benefits it provides. It's a pain in the ass to go to the doctor. True. It means you have to make a hole of a couple of hours in your schedule.

Too many put it off, and put it off, and put it off, until labor comes along. Oops! Well, then they gotta get to the hospital, and only then is the placenta previa diagosed. Maybe far into labor. That kid with trisomy 18 that could have been identified earlier is not identified. The list goes on.

Having worked in an LA County clinic dealing with high risk OB, I got a sense of it. And, truth be told, there are cultural differences. Much of America is a third-world mentality, which is expected when you have a large portion of immigrants from the thrid-world.

The access is there. It's being advertised. But the ER is there for when help is REALLY needed. By then, it is an emergency. And then it may be too late.

The SYSTEM involves everything from the operating room technology to the way the funding works to the proselytizing to the people so they are aware of what's available, and everything in between. Although parts of the US system are excellent (particularly if you are wealthy or have a good employer), other parts suck, and considered as a whole the system is no better than mediocre.

[Lindsey 0]

Timely. I just got home from work. This afternoon a young pregnant woman, 33 weeks gestation, came in after 4 days of vomiting....blood. She's positive for cocaine, and her baby's heart rate is non-reactive, which is bad. Of course she wouldn't let anyone monitor her baby for the first few hours she was there, and won't take an NG tube. She's had no prenatal care, though she has medicaid. I'm sure they're taking the baby by c-section about now.

This is not an isolated incident.

linz

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[lawrocket 3]

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Although parts of the US system are excellent (particularly if you are wealthy or have a good employer), other parts suck, and considered as a whole the system is no better than mediocre.

True. The fixes of the health care system that we saw during the 70's and 80's have caused more issues. Struggles with insurance, etc. Do you realize the folly of politicians speaking of getting eveyrone insured in one breath and bemoaning the evils of the insurance industry in the next?

I'm telling you - if I were a doctor who wanted to run a clinic, I'd start small and do things cash only. By doing cash only, I could alleviate half of my overhead with billing, oversight, etc. I'd charge $75 for a physical (which is only 2 or three times the standard co-pay) and schedule 8 per day. Leave another 10 oenings for other things. And people would probably pay for the convenience.

Health Care is different from other economic models. There are three competing interests: 1) quality; 2) affordability; and 3) availability. Cheap and available healthcare ain't gonna be that good. Quality healthcare that's affordable will be rationed. Quality healthcare that is available to all will be expensive.

I haven't figured out - nor have I heard any solution - for how to do all three. I'd like to try taking indemnifiers out of it - like insurers and the government. well, take them out of it with the exception of catastrophic illness. We wouldn't expect our home insurers to pay for a new paint job or even a new roof. But we'd expect them to cover the damage due to a pipe bursting or a fire. It's the most efficient use of the system.

Health care is expensive because everybody gets that same rate. People will have insurance and pay themselves for damage that could be covered so their rates won't go up! They have an incentive not to use it unless necessary, and they'll fork over the bread to avoid their rates going up.

When it's your money being used on you, you'll find a way to do it easily. When others are paying for it, such as in public medicine or even, to an extent, in insurance, you get less quality and less efficiency.

Along those lines, there are 4 ways to spend money:
1) Spend your money on yourself - you'll gt something you want or need for the best price and th best quality according to your needs (it's why I drive a 2002 Mercury Sable - others wouldn't think of a car like that, but it was inexpensive and fit me perfectly);
2) Spend other's money on yourself - I wouldn't be driving a Mercury Sable. i'd have that pimp Audi or Volvo;
3) Spend your money on others - it's why you get underwear and socks in your stocking. You don't like it or need it, but other people's money, so they decide what you get. You'll screw quality - you want the best price; and
4) Spend other's money on others - With this, you won't care how expensive it is, how good it is, or even if people want it. They'll get it in an arbitrary fashion.

It's why I'm such a big guy on cash only bargained for exchanges. It makes my life easier, and if I don't want to check that sore throat for 50 cents, I'll send you off.

My wife is hotter than your wife.

[niolosoiale 0]

Quote

Quote

Although parts of the US system are excellent (particularly if you are wealthy or have a good employer), other parts suck, and considered as a whole the system is no better than mediocre.

True. The fixes of the health care system that we saw during the 70's and 80's have caused more issues. Struggles with insurance, etc. Do you realize the folly of politicians speaking of getting eveyrone insured in one breath and bemoaning the evils of the insurance industry in the next?

I'm telling you - if I were a doctor who wanted to run a clinic, I'd start small and do things cash only. By doing cash only, I could alleviate half of my overhead with billing, oversight, etc. I'd charge $75 for a physical (which is only 2 or three times the standard co-pay) and schedule 8 per day. Leave another 10 oenings for other things. And people would probably pay for the convenience.

Health Care is different from other economic models. There are three competing interests: 1) quality; 2) affordability; and 3) availability. Cheap and available healthcare ain't gonna be that good. Quality healthcare that's affordable will be rationed. Quality healthcare that is available to all will be expensive.

I haven't figured out - nor have I heard any solution - for how to do all three. I'd like to try taking indemnifiers out of it - like insurers and the government. well, take them out of it with the exception of catastrophic illness. We wouldn't expect our home insurers to pay for a new paint job or even a new roof. But we'd expect them to cover the damage due to a pipe bursting or a fire. It's the most efficient use of the system.

Health care is expensive because everybody gets that same rate. People will have insurance and pay themselves for damage that could be covered so their rates won't go up! They have an incentive not to use it unless necessary, and they'll fork over the bread to avoid their rates going up.

When it's your money being used on you, you'll find a way to do it easily. When others are paying for it, such as in public medicine or even, to an extent, in insurance, you get less quality and less efficiency.

Along those lines, there are 4 ways to spend money:
1) Spend your money on yourself - you'll gt something you want or need for the best price and th best quality according to your needs (it's why I drive a 2002 Mercury Sable - others wouldn't think of a car like that, but it was inexpensive and fit me perfectly);
2) Spend other's money on yourself - I wouldn't be driving a Mercury Sable. i'd have that pimp Audi or Volvo;
3) Spend your money on others - it's why you get underwear and socks in your stocking. You don't like it or need it, but other people's money, so they decide what you get. You'll screw quality - you want the best price; and
4) Spend other's money on others - With this, you won't care how expensive it is, how good it is, or even if people want it. They'll get it in an arbitrary fashion.

It's why I'm such a big guy on cash only bargained for exchanges. It makes my life easier, and if I don't want to check that sore throat for 50 cents, I'll send you off.

Fan-fucking-tastic responses.

Another case of media getting the people rallied to blame the system when more often than not, the same people bitching and moaning are the same people testing positive for cocaine while pregnant.

I swear, so many Americans are just dumb. Expect everything to be a handout, and expect the handout to be gold-plated.

"I want free medical care, but I'll be damned if I'm going to pay another 5% in taxes."

One day these Boomers who have the "Life owe's me everything" attitude will all be dead. Of course, then we'll have to put up with their offspring who were raised the same way.

Just remember... Pensions and tax cuts today bring tomorrow's corporate bankruptcies and tax hikes.

[Nightingale 0]

There's no excuse for a lack of prenatal care. Heck, planned parenthood will provide it for free to low income women.

[misskriss 0]

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Of course she wouldn't let anyone monitor her baby for the first few hours she was there

Is the baby not a separate patient from the mother or because he/she is still in utero the mother has say so over what happens to the child inside her? I don't want to get into the abortion debate, I'm just curious because she was 33 weeks gestation.

[Lindsey 0]

Access to health care. Medicaid is run differently in different states, but here (where Medicaid is well funded) impoverished women have access to healthcare through Medicaid durning their pregnancies. Medicaid pays well, and the quality of healthcare offered to pregnant women on Medicaid isn't substandard by any stretch, I don't believe. I think you'll still find a high rate of neonatal morbidity/mortality here...probably among the highest...despite willingness of providers to treat these mothers. I believe it's much more related to other social problems than to access.

Where you find poverty and people who aren't well-educated, you'll also likely find people who aren't healthy to begin with, who aren't interested in obtaining medical care or are distrustful of the medical system. There are a LOT of substance abusers who don't stop using drugs during their pregnancies. There are a lot of people who don't take care of themselves, much less their children, and even much less their unborn children.

As far as the woman we treated today, misskriss. She had the right to walk out of the hospital at any time. She cannot be forced to accept any medical treatment that is offered unless she's unable to make decisions for herself....even if the rest of us don't like the decisions she's making, and even if her decisions negatively affect the child she's carrying.

Once her child is born, if it survives, then the child will most likely be taken into the custody child protective services. But a lot of damage has already been done.

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[peregrinerose 0]

Many people just don't give a damn about preventative or other health care. I just got off the phone with a lady with advanced diabetic retinopathy that will literally go blind without care. She has insurance, she is intelligent and working, but still refuses to get the medical care.

It amazes me how many people chose to not seek treatment. Free treatment is actually quite easy to receive. I don't know of a single doc that will flat out refuse care to someone who can't pay. We will set up payment plans, even if it is only $5 a month, regardless of the bill. Some docs, even surgeons that I know, don't even have a collections agency to turn people in to.

If patients don't ask, they can't receive services.

Do or do not, there is no try -Yoda