Abstract
Maternity coverage or insurance can be endowed by the employer or an individual can secure an insurance policy or plan by himself/herself. Taking an insurance cover by women for their maternity costs or midwives for their practice is an optional resolution. However, taking an insurance plan is beneficial compared with the reproductive complications that can result in the absence of a cover. Midwives also get covered for the services they offer and any other work related uncertainties.
Insurance in midwifery simply refers to the costs covered during the practice of midwifery, that is, pregnancy, birth, and post delivery period. Thus, maternity insurance reduces the out of pocket expenditure with respect to pregnancy and delivery. It also implies that midwives can be remunerated for their services in good time and right amount. Different insurance companies have varying packages of health insurance and specifically maternity coverage. Most of the private agencies target the well endowed group in the society whereas the federal funded insurance programs mostly target the less socio-economically endowed.
Introduction
Midwifery is an academic field that focuses on the woman and her individual reproductive and safe motherhood needs. Midwifery is also viewed as an independent area of health care practice that pays attention to pregnancy and the birthing process all of which are considered normal lifelong processes. Thus, when it comes to maternity coverage, the woman and the childbearing process deserves indemnity. In addition, the midwife or nurse-midwife should have insurance cover, whether in public or private practice. Midwives act as healthcare professionals to provide specialized care to a woman during labor, birth, and after delivery. They provide, facilitate, and educate women and families on how to experience a natural childbirth in various areas including hospitals, birthing centers, and clients’ homes . Some of the midwifery applications include provision of comprehensive health care services especially by nurse-midwives, gynecological assessments, contraception services, prenatal and post natal care, care of the newborn, menopausal management, and reproductive health education.
Being pregnant can qualify or disqualify a woman from benefiting from an insurance plan purchased by an individual. If disqualified, the woman is left uninsured during and after the pregnancy period. According to (Handler, Rosenber, Rankin, Zimbeck, and Adams 2006), the Centre for Consumer Information and Insurance Oversight has ensured delivery of midwifery services is covered in the federal government’s essential health benefits plan. For example, the Affordable Care Act (ACA) covers fundamental healthcare benefits including maternity and newborn health. Maternity and Child health is a service that are within midwifery as a discipline. The Act makes it mandatory to include specific reproductive care and treatment services. The Act also recommends utilization of the birthing centers since they are equally effective and less costly.
The American Pregnancy Association [APA] (2013) states that more than 40 million American citizens lack life insurance cover. Besides, most of the population that is insured is actually underinsured. Lack of health insurance in midwifery often leads to insufficient reproductive and safe mother hood care. On the other hand, the Centre for Disease Control and Prevention (CDC) reports that United State registered about 4 million live births in 2011 where more than 49,000 deliveries occurred out of the hospital set up. About half of these births were remunerated by Medicaid and the Children’s Health Insurance Program (CHIP). This left another 2 million women uninsured or insured in the private insurance policies.
APA further indicates that 13% of pregnant women are uninsured since the pregnancy is often viewed as a pre-existing woman state. However, the federal government established Medicaid to provide insurance policies especially to the low income earners. This organization, unlike others accepts and insures pregnant women. This improves midwifery practice since the client would be comfortable to pay of the services rendered.
Other people have continued to argue that midwifery practiced out of the hospital may be safe but always a lucrative risk for insurance firms. However, a healthcare liability policy known as “the midwife plan” is available to midwives who practice outside the hospital setting. It covers midwives who conduct deliveries at home and birth centers. Moreover, the insurance policy covers members of healthcare professional associations like the American College of Nurse Midwives (ACNM) and Midwives Alliance of North America [MANA]. It is important that insurance agencies recognized that home deliveries and birthing centers offer the same services as the hospital settings. Therefore it is essential if home births attract the same indemnity from insurance firms as hospital births. Furthermore, home deliveries have better reproductive health outcomes than hospital births..
The Royal College of Midwives (2013) enumerates that a recent policy has been introduced to indemnify health care professionals including midwives against malpractice that would possibly lead to injury, death and/or disease. This package also covers legal expenses and some students. Midwives and nurse-midwives have been regarded as better care providers for women undergoing birthing process. Besides, services offered by midwives are less expensive unlike physicians and obstetricians. Hence Medicaid has covered midwives services in several states except for Northern Mariana Islands, Virgin Islands, and Puerto Rico. Delivery of midwifery services vary from one state to another depending on scope of midwifery practice and licensure. Some states make it a requirement that the midwife enters into collaborative accords with the physician or be sponsored. In most of the circumstances, Medicaid reimburses full amounts for service in some states like Colorado and California while in others like Florida and Alabama, Medicaid reimburses between 60-85 percent of the physician fee. Services covered under Medicaid include antenatal, delivery and post delivery management of women with no medical complications. It also covers contraception services and coordination of primary care but to a limited extent. Thus, the state has created the highest amount payable to a particular midwifery service.
The Nursing and Midwifery Council for example, requires all potential midwives to arrange for indemnity plans for them to be registered and allowed to practice. The indemnity covers should be sufficient enough to cover all areas of midwifery practice including those in public service, private sector, self-employed and consultancy service and newly qualified midwives. According to (Australian College of Midwives 2011), midwives who have gone into private practice can claim Medicare reimbursements for the midwifery services provided to a client during pregnancy, labor, and birth. This can occur either in a birth center or hospital. There is also provision in the country’s private health endowments to cover midwives who are doing home deliveries. This initiative aims at empowering midwives and promoting private practice.
It has been established that physicians and obstetricians deliver majority of the babies in the United States and most of the deliveries occur in the hospital settings. This is contrary to the European Union where most deliveries are done by midwives. The implication is that women and their families pay more to delivery services in the United States (U.S) since it is done by doctors and in hospitals than in Europe. For a long time, insurance policies had no provisions for birthing centers in the U.S, this left most women especially of low income underinsured and midwives under remunerated. Midwives were under paid because they used to work in hospitals for obstetricians and physicians. However, with the advent of birthing centers insurance agencies have reviewed their indemnity policies to cover maternity in birthing centers.
This in turn has seen more women with low financial base seek midwifery services which are procured at a lesser cost compared with obstetricians. The American Pregnancy Association (2013) indicates that more than 15% of deliveries in New Mexico and Oregon are conducted by midwives, whereas in Denmark and Britain, more than 60% of births are done by midwives. However, there still remain some employers who deliberately remove midwifery care from the list of covered benefits. Furthermore, some insurance agencies tend to ignore midwives in their negotiation with big associations of physicians.
Lobbyists have fought hard to reduce insurance premiums, which have continued to increase over the years by nearly 131% especially for maternity coverage. Hence families have been forced to spend a lot of money for a condensed coverage. This increase in rates varies from one state to another. However, it limits the ability of women and families to acquire adequate reproductive health services especially from midwives.
The Deficit Reduction Act (2005) permits the implementation of the Medicaid reform that has four indemnity plans. One of them is the standard benefit plan (global choices) that targets women who are pregnant and those with reproductive cancer. However, this plan is more cost sharing and does not cover long-term midwifery care. The second plan covers children (family choices) and has no cost sharing for children who are traditionally covered by Medicaid. Despite the different packages present in Medicaid, members of the insurance organization have the responsibility to make payments for some services. However, if one is eligible for both Medicaid and Medicare, then he/she is exempted from cost sharing.
Women, Infants and Children (WIC) are another federal run agency that contributes to midwifery. This agency aims to safeguard and promote the quality of life of low income families, and children under five years old. It provides dietary supplements, nutritional counseling, and relevant referrals. This program covers a significant part of midwifery since there is focus on the women and child. Medi-cal is also another state funded program that is run in California. This program also provides insurance to maternity services. Medicaid and CHIP policies cover pregnancy related care to complications that warrant emergency care. Other services covered include psychosocial and conception counseling, case management, management of drug and substance abuse, home based care and follow ups. These policies help at enhancing better outcomes of pregnancy and childbirth. Hence there has been a reduced premature births and better maternal and child health. According to American Pregnancy Association (2013) delivering in a birthing centre may cost $3,500 on average whereas in a hospital the cost may be twice. Thus, birth centers would be more suitable to low income earners since also Medicaid is accepted.
(Callahan and Farley 2005) argue that most women choose a midwife to an obstetrician because they would want to have a natural experience of childbirth. Moreover, midwives enable their clients choose from a variety of payment options including sliding fees and Medicaid among others. Midwifery services have been associated with more affordable costs and reduced unfavorable complications. Furthermore, Medicaid is a more preferred plan because its regulations are more friendly and reasonable especially for the financial disempowered. However, Medicaid has stricter limitations to an individual than to a pregnant woman. Thus, midwives can encourage their clients from low socioeconomic backgrounds to consider taking up the federal funded insurance agency (Medicaid) when they are pregnant. Lastly, health insurance and specifically maternity coverage helps one attain peace of mind since expenses are settled by the insurance agency or organization. Hence reduces stress and financial anxiety.
Conclusion
Midwifery as a health care practice is a fundamental service provided to women during pregnancy, birth and post delivery. Insurance coverage of midwifery activities not only allows the woman to experience a natural birthing process, but also improves outcomes of general health. However, it is anticipated in early 2014 that comprehensive health coverage including maternity shall be increased to cover majority of the population. However, for this to be fruitful, a lot of health care reforms and policy formulation need to be done so as to allow a better coverage of services offered at home, birthing centers and hospital settings.
References
American Pregnancy Association. (2013). Maternity Insurance. Retrieved December 3, 2013, from www.americanpregnancy.org: http://americanpregnancy.org/gettingpregnant/maternity-insurance.html
Australian College of Midwives. (2011). Eligible Midwives. Retrieved December 3, 2013, from www.midwives.org.au: http://www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccms.r?PageId=10181
Callahan, M., & Farley, C. (2005). Effects f the Medical Liability Insurance Crisis on Physicians. Journal of Midwifery and Women's Health , 544-594.
Centers for Diseas Control and Prevention. (2012, October). Health Insurance Marketplace. Retrieved December 3rd, 2013, from www.cdc.gov: http://www.cdc.gov/aca/marketplace/
Handler, A., Rosenber, D., Rankin, K., Zimbeck, M., & Adams, E. (2006). The pre-pregnancy insurance status of public aid recipients in the aftermath of welfare reform: women in the Medicaid gap. Journal of Health Care for the poor and underserved , 162-179.
Ku, L. (2009). Health Insurance Coverage and Medical Expenditures of Immigrants and Native born Citizens in the United States. American Journal of Public Health , 1322-1328.
Simon, K., & Handler, A. (2008). Welfare reform and insurance coverage during the pregnancy period. Women's Health Issues , 97-106.
The Royal College of Midwives. (2013, June). Independent Midwives and Medical Malpractice Insurance. Retrieved December 3, 2013, from www.rcm.org.uk: http://www.rcm.org.uk/college/membership/membership-info/independentmidwives/
