Costs cut care for pregnant poor

De facto rationing of medical care to some Americans has already begun, many medical experts says. Preliminary results of a study under way into the effects of the current medical-liability crisis support the view. The Medical Professional Liability Study, which focuses on obstetrical care, is being conducted by the Institute of Medicine of the National Academy of Sciences. Members of the study include ``almost equal numbers of lawyers, doctors, and people from the insurance industry,'' says Dr. Roger J. Bulger, the study chairman.

``Preliminary indications,'' study director Victoria P. Rostow says, are that the impact of the high costs of liability insurance ``is, in fact, affecting care'' to poor women. Obstetricians increasingly report they are no longer providing care to women for whom medicaid is paying, or for high-risk women. US governors report that medicaid programs in many states have faced ``significant problems'' in obtaining access to obstetrical care for the poor, she says.

In addition, Ms. Rostow says, there are ``significant access problems in rural areas'' for pregnant women. ``As many as 23 percent of family physicians,'' who provide much of the obstetrical care in rural areas, report that they have stopped providing it because of the high cost of obstetrical insurance.