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I never thought I would write a blog about women’s health, especially in the professional capacity of a property and casualty actuary. But this year, one after another, events began to impact my views. A former roommate suffered from preeclampsia. A friend gave birth to a 32-week preemie. My niece was born. Then, the last straw was a study released by Doximity on July 20th warning of an impending OB-GYN shortage since nearly 40% of OB-GYNs in the U.S. are aged 55 or over. The confluence of these events brought to my attention the importance of well-woman and mother-infant care, the medical issues that can arise during pregnancy and delivery and the need for well-trained medical providers. These concerns, as well as the need for more overall attention to women’s health, will pose significant challenges for medical professional liability insurers in the coming years.
Social and economic demographics alone pose serious concerns for insurers and policymakers. Women are waiting longer to have children, and the possibility of complications dramatically increases for older mothers. Maternal mortality is increasing in the U.S. while decreasing in other developed nations, as the below graph (original source, The Economist) illustrates. Health care is more available than ever, but fewer OB-GYNs may mean longer waits for routine or pre-natal care, as well as physicians who are more stressed and vulnerable to mistakes. Add to these the myriad of other health crises in the U.S. (opioid abuse, obesity, etc.), and we may see an increase in both the frequency and severity of OB-GYN claims.
As OB-GYNs become scarcer, midwives may be handling a much larger portion of births and well-woman care. Many states now allow nurse midwives to practice without a doctor’s supervision and provide routine female care in addition to attending births. According to the Bureau of Labor Statistics, the number of nurse midwives in the U.S. increased about 18% from 2014 to 2017. Midwifery organizations continue to pursue opportunities to expand licensing and practice for their members without the nursing designation. In the coming years, insurers may need to learn how to adjust a physician-focused model of pricing and claims handling to create a midwife-focused model.
Policy changes are already shaking up the legislative environment. Some states are considering financial incentives for medical students who pursue an OB-GYN specialty, and options that reduce or subsidize premiums may play key roles in future legislative actions. States may be more open to implementing birth injury funds, which can relieve financial pressure on OB-GYNs while still providing protection to patients. Tort reform may become a higher priority in state legislatures. The high visibility of women’s health issues ensures that policymakers will stay active in the coming years.
When I recently scheduled an OB-GYN appointment, the first available opening was nearly two months out. Many women already wait months to see a physician for routine care. The critical nature of the aging OB-GYN workforce is clear, and this crisis will force some substantial changes for both patients and insurers.
Bureau of Labor Statistics
Christina Henry is an Actuarial
Analyst with Pinnacle Actuarial Resources, Inc. in the Bloomington, Illinois
office. She holds a Master of Science degree in Actuarial Science from Illinois
State University and a Bachelor of Arts degree in Mathematics from Cedarville
University. Christina has experience in assignments involving Loss Reserving,
Funding Studies, Loss Cost Projections and Captive Feasibility Studies. She is
actively pursuing membership in the Casualty Actuarial Society (CAS) through
the examination process.
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