“No-fault” insurance that covers a pregnancy and birth
The author envisions one-child-at-a-time policies that will blunt the OB malpractice crisis. Could it work?
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Coverage comes one pregnancy at a time. A 3MLI policy covers an individual pregnancy. In the event of an adverse outcome, the patient preserves her right to sue. The policy provides liability insurance to cover the cost of a lawsuit and payment for an adverse outcome or a system to assist a disabled infant and its family.
Quality assurance is built in. For a pregnancy to be covered, the system requires a guideline-based, quality assurance system to optimize 1) the quality of care and 2) record keeping. Only OB providers who agree to participate in all aspects of the 3MLI system would have medical liability coverage—coverage that includes full participation in case reviews for adverse outcomes as well as use of record systems and appropriate guidelines for OB care.
It offers an attractive no-fault option. When a disabled infant is born or other adverse outcome of an insured pregnancy occurs, 3MLI provides parents with a no-fault settlement option as an alternative to filing a malpractice suit. Medical care needed by the infant or mother as a result of complications to pregnancy, a congenital defect, or perinatal mis-adventure not otherwise covered by primary insurance or a government agency would be covered by 3MLI for as long as needed—in some cases, for life. Women who choose this option forego the right to sue, with all the delays and uncertainties that malpractice lawsuits typically involve.
It provides case management. The no-fault policy also includes the services of a case worker to advocate for mother and child. The case worker coordinates the involvement of the primary health insurance company, HMO, government agencies, and other third-party payers, as well as charities, community support groups, and other agencies—all in the interest of providing the best and most effective care possible.
The case worker receives legal assistance to mobilize resources and assistance in a timely manner, thereby promoting a good medical outcome. Case management services continue to be available for a disabled child, even after the death of parents and other family members. Note that these services can be utilized during the pregnancy (coordinated with the OB provider) to help prevent adverse outcomes, as well as after delivery.
It offers life insurance and legal advocacy. The no-fault settlement option includes life insurance for the mother and offspring and pays for legal counsel to advocate for the rights and benefits of the pregnant woman during pregnancy and the injured or disabled party (if any) afterwards. This lawyer could not serve as a plaintiff attorney, and would be paid for services rendered—not on contingency. Legal tasks could include:
- working with the case worker to secure appropriate and timely care when red tape and bureaucracy threaten to deny or delay it
- helping to prevent further adverse outcomes
- designing trusts for the long-term maintenance and care of a disabled infant.
Bad outcomes that arise from a poor system of care, physician error or negligence, government regulation (such as bureaucratic delay in initiating care or regulations that prevent optimal OB care), or any other cause are objectively categorized, and recommendations for improvement are made. Case reviews are undertaken by national professional organizations, such as the Society for Maternal–Fetal Medicine and the American College of Obstetricians and Gynecologists (ACOG), and local committees.
These reviews are then fed into a central database that permits objective understanding of the magnitude, and possible causes, of infant disability. The impact of such studies would be to prevent similar problems, when possible, and to provide the most appropriate care, when necessary. Individual practices and physicians are accredited by ACOG or the American Board of Obstetrics and Gynecology (ABOG) before being allowed to participate in this program.
