In addition:
The insurer is a nonprofit, mutual insurance company. Each policyholder has a voice in how the system functions. 3MLI must be a mutual company that maintains long-term potential value to the patient who owns the policy. It must never be allowed to demutualize, so to speak, or to be run by a for-profit company.
The policy has a specified life. A 3MLI policy lasts from the time it is purchased, in pregnancy, until the child reaches 21 years of age (unless, in the case of a bad outcome, the lifetime medical and support benefit is activated). At some time, it is possible that the policy could be converted to another form of mutual health insurance for children who do not have a disability.
Coverage. Questions about which infants need assistance and how disability is defined can be resolved by families, physicians, and legal counsel available to each family as part of this plan. Note that no large financial payment occurs under the no-fault settlement option, so a financial incentive for fraud by the family of the disabled child does not exist.
The 3MLI system is a mutual insurance system with potential benefits (such as dividends or paid-up insurance) to the mothers and families only if money is left in the system. This motivates systemic efficiency and appropriate use of resources, and encourages improving OB care from the patient population point of view.
What is the foundation of such a system?
3MLI would be structured as one, or more, insurance companies set up to provide the services that I’ve outlined. Rather than directly providing all health-care funding for disabled infants, 3MLI would obtain access to, and help maintain, existing health insurance policies and draw on other resources, when available. These could include, as needed, Medicaid, SCHIP, charity and government-run early-intervention programs, and private providers. In short, it would use collateral sources of health care and other resources in fulfilling its mission.
A 3MLI insurance system might also arise from physician-owned mutual medical liability companies or from self-insured medical liability systems, such as the ones found in large hospital systems. HMOs or health insurance companies could develop a 3MLI system as well. Government-related institutions and universities or state health departments with a need to find OB care for indigent populations could also develop 3MLI insurance systems. Initial funding could also come through demonstration projects underwritten, in part, by government or foundations.
Everyone, I believe.
Patients win. The continued availability of high-quality OB care—threatened now by the loss of affordable malpractice insurance—is the most important benefit for patients. In the event of an adverse outcome, parents who choose the settlement option have guaranteed access to immediate health care and other assistance, for as long as they need it.
So do physicians. Participation in 3MLI allows physicians to continue practicing OB after they are priced out of the market by the cost of standard medical liability insurance.
Professional organizations win. Participation by organizations like ACOG is a way to support their physician-membership and their members’ patients. In addition, participation ensures that professional organizations have access to databases and that they be able to assist in creating practice guidelines that evolve from their participation.
The states. Many low-income families depend on state assistance for OB care and for the care of disabled children. So, state governments have a substantial stake in the continued availability of OB care and in providing long-term care for the disabled. Many states (New York, for example) already provide a comprehensive system of care for persons who have a significant neurologic disability. 3MLI is designed to coordinate with such state-run systems, thereby increasing their efficiency and effectiveness.
Hospitals. When a significant number of staff physicians participate in a 3MLI system, the hospital benefits from a drop in medical liability claims and suits. Hospitals and hospital systems may find it to their advantage to help initiate or support a 3MLI system.
Attorneys. New, key roles for lawyers will be created in helping to prevent poor medical outcomes before they occur. For example, prenatal care that includes the need for prolonged maternal rest may need legal assistance in a disability dispute. Lawyers also give lifelong assistance to disabled infants and their family.
Lawyers would be paid for these important services without having to participate in litigation. Litigation would continue to be an option if needed or desired by the injured party.
No reason to wait
The progressive severity of the obstetrics liability crisis provides a window of opportunity to propose, consider, and then construct a solution like Mothers Mutual Medical Liability Insurance. Above all, we must consider the needs and well-being of our patients. The time to do this is now—before the loss of OB services places women and their babies at risk.