An important fact about our babies was lost in recent news, given all the distractions caused by the presidential wrestling matches. According to a recent report from the U.S. Centers for Disease Control, infant mortality rates in the United States decreased by 2.3 percent between 2013 and 2014, down to 582 deaths per 100,000 live births. Although this is the lowest U.S. infant mortality rate ever recorded, compared to other countries, we still have a long way to go, baby.
In 2014, more than 23,000 U.S. infants died. That works out to an infant mortality rate that is three times Finland’s. An article in the Journal of the American Medical Association last month showed that, compared with all other industrialized countries, the infant mortality rate in the U.S. falls into 26th place.
Why are we near the bottom for this health measure? The authors of the article point out that it is not because we spend less: We spend double what the average industrialized country does for health care. It doesn’t come from a lack of high technology: We actually lead the world in both the number of neonatal intensive care beds and the number of specialists to care for our neonates. It is not because of “Obamacare” because our dismal performance in this arena long predates this new health care legislation. Instead, the authors believe the uncomfortable truth lies in the very structure of our health care system, which does not provide the type of seamless, coordinated care for our pregnant patients and infants that is enjoyed by those in the health care systems of other countries.
The main factor that contributes to the high infant mortality rate in the U.S. is the number of premature births, which occur more often in poor, immigrant and inner-city communities. It is less dangerous and less expensive to prevent premature births than it is to treat premature babies after birth. Access to health care is important to prevent bad outcomes.
In countries like Finland, doctors’ offices and clinics are better distributed and in closer proximity to high-risk populations. Also, there is a higher degree of coordination of care between primary care providers and the high-risk pregnancy specialists.
As an example to show how these factors work to influence pregnancy outcomes, let’s examine how the treatment of urinary tract infections — a known cause of preterm labor — differs in the U.S. compared with most European countries. Unlike in the U.S., every primary care office in Finland welcomes pregnant patients. Someone with early signs of infection would not need to drive herself or get a ride to some distant hospital to be seen because clinics are nearby. Also, all clinics and hospitals use the same electronic medical record, so if there were a question about the best treatment for the woman with urinary tract infection symptoms, the providers in the neighborhood clinic can get an immediate consult with the obstetrician at the nearest high-risk center. Finally, the medication necessary to prevent the preterm labor would be either free (paid for by taxes) or very affordable and usually dispensed right at the clinic site to ensure quick compliance with the needed treatment.
Obviously, we need a more patient-friendly process in the U.S. There are many obstacles in our current system which include:
— High liability costs that prevent local clinics from seeing pregnant women.
— Maldistribution of medical resources.
— Poor incentives for providers to help these patients (for example, insurance will not pay for the services of a high-risk obstetrician unless the patient physically goes to that provider’s site).
— An electronic medical record that is still inefficient and often unable to communicate with others.
— A complicated and confusing pharmaceutical and insurance system.
Our intention is to build awareness of the types of changes in our health care system that could improve the quality of perinatal care. As we progress in the election cycle, it may be important to recognize that we do not have the “best medical system in the world,” particularly for our more vulnerable communities and small patients. With this information, we are more prepared to have an honest and thoughtful conversation about how we can improve all lives — big and small.
Dr. William Sturrock is president of the Maine Academy of Family Practice. Dr. Janice Pelletier is president of the Maine chapter of the American Academy of Pediatrics. Dr. Jack Forbush is immediate past president of the Maine Osteopathic Association. They all practice in the Bangor area.