The financially pressed Group Health Association, a prepaid medical plan that provides health care to 115,000 Washington-area residents, has announced that delivery of babies by a physician and hospitalization afterward are "no longer routinely provided" to its federal employe members.
GHA instead is offering delivery "in a birthing facility by a plan-certified nurse midwife under supervision of a plan obstetrician" unless hospitalization and delivery by an obstetrician "is medically indicated."
The changes, which constitute the first time that a local health plan has declined to routinely guarantee hospitalization and delivery by a physician to expectant mothers, underline the severe financial crunch confronting GHA, one of the oldest health maintenance organizations in the country.
GHA officials say the nurse midwife program, which has been offered since 1974, is one of the plan's most popular and that no woman will be denied delivery by an obstetrician if she requests it.
Phil Schalet, GHA's marketing director, termed the wording in the official announcement "unfortunate" and "painfully honest." The announcement went to federal employes, who are now in an "open season" for choosing or changing health insurance, and who are the only GHA members currently affected by the policy change.
Schalet said three factors will determine delivery practices: patient preference, medical eligibility and the availability of a facility.
"No GHA patient has been or will be forced to have a delivery by a nurse midwife if she wants to have an obstetrician perform the delivery," Dr. Edward J. Hinman, GHA's executive director, said. But, he added, "We will be encouraging aggressively, actively this short-stay, midwifery program."
Economic incentives will be offered to pregnant women to encourage them to use nurse midwives and to limit their stay in the hospital to less than 24 hours after delivery, according to Hinman. Encouraging short hospital stays after delivery is a new policy.
As outlined by Hinman and Schalet, the increased stress on nurse midwife delivery coupled with a short hospital stay is part of GHA's effort to reduce costs. Experts outside GHA questioned whether the announced change would attract the young, basically healthy members that the plan must attract to correct its financial problems.
According to its 1981 annual report to its members, GHA had an operating deficit of more than $1 million. This year, according to Hinman, the plan has projected "a significant deficit." Although Hinman declined to name a figure, he estimated that the deficit would be "several million dollars."
GHA's president, Abraham A. Raizen, attributed the 1981 deficit to higher than expected costs coupled with "slower growth . . . than planned." Between 1980 and 1981 GHA added fewer than 2,000 new members while the Kaiser-Georgetown Community Health Plan, another prepaid medical plan, grew from 55,000 to 80,000 members.
Along with other health plans, GHA next year is significantly increasing the premiums that federal employes -- who make up roughly half GHA's membership -- must pay to participate. Monthly premium increases paid by the federal employes for the four plans GHA offers them are going up from 14 per cent (high option individual) to 126 per cent (low option family).
Despite these increases, GHA will still have lower employe-paid premiums for its high option plans than Blue Cross-Blue Shield, the most popular of the insurance programs available to federal employes. The Kaiser plan offers only a high option plan, and its 1983 rates are lower than GHA's high option and slightly more than GHA's low option.
GHA, like other prepaid medical programs, provides physician care and hospitalization to its members, who pay a premium but no fees -- or only a nominal charge to the plan -- when they are seen by a plan physician or nurse.
Although Hinman said the announced change in obstetrical procedures "has raised some eyebrows," Schalet said that he has had "very little question about it" in recent meetings with federal employes who are deciding on their insurance coverage.
Blue Cross-Blue Shield has covered nurse-midwife deliveries in hospital-affiliated birthing centers at the patient's option since last January.
At the moment, the only hospital GHA uses that allows midwives to perform deliveries under an obstetrician's supervision is George Washington University Hospital. GHA considers George Washington too expensive for routine medical procedures, and it is negotiating a birthing facility "approach" with four hospitals, Hinman said. He declined to name the hospitals.
Columbia Hospital for Women, which GHA uses for gynecological procedures, has rebuffed the plan's efforts to use midwives for births there.