States move ahead on easing access to gynecologists
BYLINE: Rita Rubin
BODY: While proposed federal legislation languishes, many states
have expanded contraceptive coverage and women's access to
Since 1995, 35 states and the District
of Columbia have adopted policies allowing women in managed care plans to
see OB/GYNs without a referral from a family doctor or internist, according
to a report by the Kaiser Family Foundation, which is holding a news
briefing today on women's health policy. And 10 states -- nine in the past
year -- have passed laws requiring private insurers to cover all
contraceptives, according to the foundation.
"The regulation of
insurance has always been a state responsibility," says Diane Rowland,
executive vice president of the foundation. A stand-alone federal law
improving women's access to OB/GYNs is unlikely, Rowland says, but such a
measure is part of the omnibus patients' rights bills pending in Congress.
A September 1998 survey by the National Partnership for Women
and Families in Washington, D.C., found that women strongly supported
direct access to the doctors, says Judith Lichtman, president of the
organization. "Women have very different primary-care needs than men,"
Lichtman says. "Often, maybe always, those needs are best met by having
direct access to OB/GYN services."
Research suggests that women are
much more likely to get preventive services such as pelvic exams and Pap
smears if they go to an obstetrician/gynecologist instead of another type of
doctor, according to the Kaiser report.
Although women in 15
states and D.C. can pick an OB/GYN as their primary-care provider, many
doctors in that specialty would rather not fill that role, says Richard
Bondi, a board-certified OB/GYN who serves as Northeast medical director for
women's health for Aetna U.S. Healthcare.
"They don't want to be
treating broken bones or pneumonia," Bondi says.
would like to be able to prescribe the birth control that best meets their
patients' needs. But cost is sometimes an obstacle because many health plans
do not cover the full range of options, according to Kaiser. In a survey,
Kaiser found that 39% of fee-for-service health plans cover reversible
contraceptives such as the diaphragm and IUD.
legislation would require all health plans that cover prescription drugs to
cover contraceptives, but its chances of being enacted any time soon are
remote, says Kathryn Kolbert, a senior researcher at the University of
Pennsylvania's Annenberg Public Policy Center.
"Both as a public
health matter and a matter of equity, women and their male partners ought to
have a choice of the method they use," Kolbert says. "Where you live
shouldn't determine the quality of the care you receive."