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The Rostrum



Reducing infant mortality in Illinois




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RICHARD J. DURBIN

Last fall I was host to two congressional hearings which addressed the high infant mortality rate in Illinois and considered pregnant women's access to prenatal care. During the hearings, two congressional colleagues and I visited the neonatal intensive care unit at St. John's Hospital in Springfield and Children's Hospital in Chicago. These units are an amazing, tragic sight, where an infant's life support is often a machine and where mothers stare helplessly through windows at their tiny babies.

As a member of the House Select Committee on Children, Youth and Families, I requested the hearings in order to give other members of Congress a personal look at this statewide crisis, and to focus on the tragic problem of infant mortality. There is no one cause for infant deaths or for premature births, but when one cause — access to prenatal care — seems apparent, something should be done.

Our national infant death rate is shamefull. So is Illinois'. According to th Children's Defense Fund, the Illinois infant mortality ranking among 20 industrialized nations declined from the sixth in the 1950-55 period to 19th in 1980-85. An infant born in a third world country like Jamaica or Trinidad has a greater chance of survival than a black baby born in Chicago or a child born in Pulaski County in downstate Illinois. Each year low birth weight babies in Illinois die or face the need for long-term medical supervision. IIlinois is among the top 10 states with the highest infant mortality rate. In 1986, IIlinois had 2,125 infant deaths.

Illinois has made some progress in reducing infant mortality since 1978, but we have a long way to go in order to meet the U.S. Surgeon General's prescribed infant mortality reduction goal for the 50 states ("9 by 90," or a reduction to 9 deaths for every 1,000 live births nationwide by 1990). 1986 statistics from the Illinois Department of Public Health show 12 infant deaths for every 1,000 live births in Illinois in 1985 (compared with 10.6 nationwide).

What is causing this high infant mortality rate? One factor is the unavailability of adequate prenatal care. Approximately 11,000 low-income women in Illinois receive little or no prenatal care each year. Without early, comprehensive care, pregnant women are three times more likely to deliver low birthweight infants.

For those seeking prenatal care, finding a doctor can be a problem, especially for low-income patients. Many poor women without health insurance are having difficulty getting access to a doctor. One reason: the low Medicaid reimbursement rates paid to obstetricians in Illinois.

Many doctors face a financial loss in treating a Medicaid patient. For example, the average cost charged by an Illinois doctor for prenatal care, including delivery, is about $1,200. Our state's Medicaid reimbursement rate for that care, however, is only $447. The reimbursement rate in Illinois lags well behind other states in the nation, including those with a high urban population. The reimbursement rate for Massachusetts is $1,027; for Georgia, $800; for California, $721.68; and for New York, $550. Illinois' Medicaid reimbursement rate is even lower than the over-all national average of $473.


March 1988 | Illinois Issues | 42


Another problem for our state's obstetricians is the high rate of malpractice insurance. One doctor in Illinois saw his malpractice premium increase from $37,000 annually to $47,000 for six months. This obstetrician, in the prime of his career, had to weigh seriously whether he should close his practice. His experience is not isolated. Obstetricians have become especially vulnerable to lawsuits from mothers who sue after their babies are born at a low birthweight or with defects. As of 1985, 12.3 percent of obstetricians nationwide had given up obstetrics due to liability pressures. This hits hard in rural llllinois communities, many of which are now experiencing a lack of local obstetrical care.

We must quickly work for solutions to these problems. The National Center for Health Statistics shows that Illinois will have to triple its current rate of progress by 1990 to meet the Surgeon General's goal.

There are existing programs benefiting Illinois that need support. The National Health Service Corps Program is a federal program which polls physician resources for local community health centers, such as the Community Health Improvement Center (CHIC) in Decatur. In recent years the Reagan administration has proposed eliminating the National Health Service Corps. It provides medical care to low-income women in underserved areas, many of which are rural. When you consider that CHIC in Decatur serves an estimated 5,000-6,000 low-income patients, 70 percent of whom are on public assistance, it seems hardly cost-efficient to eliminate the program. It would mean that underserved areas in Illinois would be left with only emergency services, and in some places with no medical services at all.

In addition, every community can look for its own local response to the problem. In response to an article last year by Don Sevener in the Illinois Times, which focussed on access to prenatal care in Springfield, I met with medical officials about the possibility of expanding maternity care services at St. John's Hospital. This new program would center on low-income mothers. I hope we can soon see this deserving concept become a reality.

One federal program is not being used by our state to combat this problem. Despite its eligibility, Illinois has not followed the lead of 23 other states in taking advantage of a program passed by Congress last year that allows states to expand Medicaid coverage to low-income pregnant women and young children. I hope Gov. James R. Thompson will seriously consider the advantages of this federal-state cooperative program.

Preventive programs are cost-effective ways to reduce infant death rates. The estimated cost of delivering comprehensive prenatal care to all poor, pregnant women in the U.S. is about $1 billion, in contrast to the $2.1 billion we as taxpayers will pay for the care of low birthweight babies this year. The U.S. General Accounting Office also calculates that for every $1 spent for prenatal care $3.30 can be saved in the costs of care for low birthweight infants.

Congress is looking at the cost-effectiveness of further expanding Medicaid coverage to help low-income pregnant women. As a member of the House Budget Committee, I strongly supported including "The Children's Initiative," a legislative package expanding several cost-effective programs benefitting children, within the 1988 Budget Resolution. I will fight to increase the funding level again in next year's budget.

On the state level, we must work in a bipartisan, intergovernmental fashion on the need to increase the Medicaid reimbursement for obstetricians, and we must examine the malpractice dilemmas they face. We can also increase support for several state infant mortality programs already initiated through the Illinois Department of Public Health.

Finally, at all levels, we must inform low-income women about the importance of prenatal care and where to get it. Later this spring I will be working with other members of the Illinois congressional delegation and state leaders in a statewide effort to reach low-income mothers. We must move now to avoid the huge costs in medical care and human life that accompany high infant death rates.□

Richard J. Durbin (Democrat) is a member of the U.S. House Select Committee on Children, Youth and Family and represents the 20th Congressional District in Illinois.


March 1988 | Illinois Issues | 43



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