MANAGED CARE DISREGARDS HUMAN COSTS

To the editor: I have been reading the articles and letters to the editor in Business Insurance regarding the mandate of coverage for a minimum two-day hospital stay for new mothers.

As would be expected, because your publication is for people in the insurance industry, the slant has always been toward the "drive-through" types of maternity stays, with lots of statistics that purportedly show that it's quite all right for a woman to be forced out of the hospital shortly after giving birth. And, of course, most of the short-stay advocates are men who have never experienced labor. A Sept. 15 letter is about how awful it would have been if we had gone back to 1950 and mandated coverage for a 10-day stay, with all the attendant infections that would be sure to result.

Yes, short stays save money for the insurance companies. And 10 days would be excessive. But medical care is about more than money, a fact managed care organizations consistently forget.

Human beings are not products to be shuttled through production lines. And, if mandating coverage for longer stays is so wrong, why is the insurance companies' mandating coverage for 24 hours or less right?

Your writers completely forget, and even discount the experiences of, those women who truly suffered from being forced home too soon after giving birth. Those experiences are shrugged off as mere "anecdotal evidence" of the problem of being sent home too soon. But the experiences are real and are troubling.

I was forced home after 24 hours. My son was a very large baby, and I had a vaginal delivery after 37 hours of labor, most of it without anesthesia. The damage he did to me was extensive.

My insurance company felt they were making up for putting me through this by providing two nurse's visits to my home. The nurse examined me and my baby, but she couldn't help me get rest and make meals or do the laundry-things I wouldn't have had to do if I was in the hospital.

Many women are fortunate and suffer very little damage from childbirth, and they should go home as soon as possible. But to force all women, regardless of the circumstances of their deliveries, to go home where they might not have any support is unconscionable and, as far as I'm concerned, bordering on criminal.

Forcing me home cost the insurance company less money than if I had stayed one more day. But it cost me an immeasurable amount in pain, despair, fatigue and depression, and no doubt caused it to take me longer to heal and longer to bond with my son.

That's a real cost-but I guess not in your eyes, because it didn't cost you anything.

Perhaps what we need to do is put the male insurance executives who make these cruel decisions through some sort of tissue-tearing, marathon-length torture and see how they come out of it. Try passing a bowling ball-sized kidney stone, experiencing the pain and the physical damage, and then tell me it's OK to be sent home within 24 hours of doing so.

The reason managed care gets the bad press it does is because it pays absolutely no attention to the human side of the equation. It's only about money. Medicine used to have an element of compassion, and the managed care industry has taken that away. The two are not incompatible, and perhaps managed care needs to explore ways to ensure the best care at the lowest cost-not the cheapest care.

Liz Bligan

Wayne, Pa.