Clinics hurt as insurance cost climbs Required services being cut, dropped

August 21, 1991|By New York Times News Service

WASHINGTON DHC GVB — WASHINGTON -- Rising malpractice insurance costs are forcing many of the nation's 600 community health centers to cut back or eliminate some services for low-income patients they are required to treat under federal law.

Malpractice insurance costs for some clinics have risen 30 percent to 40 percent in the last year and have increased more than fourfold in the last decade, even though many of the clinics have not paid a penny in malpractice claims to patients.

The premiums have increased much faster than the grants provided by the government.

As a result, some clinics are cutting services, especially care for pregnant women, and many have had trouble recruiting and retaining doctors because they cannot afford insurance. Clinics say they are cutting back on procedures that are considered to be most likely to generate malpractice claims.

While malpractice insurance premiums have leveled off for some medical specialists, insurance companies are charging higher premiums for many community health centers, in part because the insurers see poor people, especially pregnant women, as bad risks.

Such people, they say, often avoid contact with doctors and hospitals until their medical problems become acute.

Marc H. Rosenberg, vice president of the Insurance Information Institute, a trade association, said insurers set rates for large groups of health care providers and generally did not have the data needed to set rates specifically for doctors at non-profit clinics.

There is no indication that insurance premiums for community health centers have risen much faster than those for private doctors providing similar services. But directors of the community clinics say they cannot pass on the added costs to patients because the patients generally cannot afford to pay more.

Managers of community health centers, members of Congress and officials in the Bush administration agree that the 600 centers, which serve 6 million low-income patients at 1,500 clinics, have been forced to pay too much for private insurance, in view of the small number of malpractice claims paid on their behalf. But they are divided over how to address the problem.

The centers are spread across the country and are the only source of care for the indigent in many rural counties and some inner-city neighborhoods.

They receive federal money under current law only if they serve ** an area with a high infant mortality rate and a high poverty rate. Of the patients treated last year, 250,000 were pregnant women and 2.9 million were under 18 years old.

The centers got $530 million this year from the federal government and are paying $58 million for insurance, about 15 times the amount paid out by insurers on claims against the clinics. In 1988 the clinics' malpractice premiums totaled $30 million.

The clinics' premiums usually reflect the cost of insurance for themselves and for their doctors, nurses and other health care professionals. The more health care workers a clinic has, or the greater the number of high-risk procedures it performs, the higher its premiums climb.

While the clinics can use federal money to help buy insurance, vTC they say the rising costs for such insurance mean they have less money available to provide direct care for patients.

For example, Edwin W. Brown, executive director of Florida Community Health Centers, a private non-profit corporation, said his clinics at Fort Pierce and Okeechobee recently discontinued obstetric services because of malpractice insurance costs. The premium for an obstetrician this year would have been at least $110,000, he said.

In New York, the Peekskill Area Health Center, which serves five counties north of New York City, reports that its malpractice insurance premiums rose about 30 percent this year, to $218,000 from $168,000. Anne K. Nolon, executive director of the center, said the clinic and its insurers had not paid any malpractice claims in 15 years.

Premiums for some clinics in Rhode Island are up 40 percent this year. Dr. Stanley Hoyt Block, medical director of the Providence Ambulatory Health Care Foundation, which operates five community health centers in Providence, said malpractice insurance premiums had risen to $277,000 this year from $198,000 last year, even though "we have never had a penny given out by our insurer because of malpractice by any of our employees in 24 years."

Dr. Block said the clinics had to cancel some evening appointments because they could not cover the added cost of malpractice insurance for consulting physicians.

"We are not getting doctors to moonlight for us when we need them," he said. "The wait for a new appointment is three to four months at our busiest centers. Some retired doctors are willing to work at our centers, but neither they nor we can afford a $7,800 insurance policy for a pediatrician to work a few hours a week."

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