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Published by: Harvard Kennedy School
Published in: 1992

Abstract

When obstetricians at the sole hospital in affluent Montgomery County, Maryland, treating poor women decide the financial risks of such service outweigh its benefits, the county confronts a health care crisis. The group of women most in need of pre-natal care, and the group most likely to have delivery complications, had found itself without access to such services. The county health department had to find a way to arrange for obstetrical care for poor women to continue. Its options ranged from providing the service itself to offering the insurance protection of the county to private physicians so as to induce them to resume their work. The case provides a vehicle for discussing how government should decide what kinds and levels of private services there are in which the public has an overriding interest-such that some sort of public investment is appropriate.

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Abstract

When obstetricians at the sole hospital in affluent Montgomery County, Maryland, treating poor women decide the financial risks of such service outweigh its benefits, the county confronts a health care crisis. The group of women most in need of pre-natal care, and the group most likely to have delivery complications, had found itself without access to such services. The county health department had to find a way to arrange for obstetrical care for poor women to continue. Its options ranged from providing the service itself to offering the insurance protection of the county to private physicians so as to induce them to resume their work. The case provides a vehicle for discussing how government should decide what kinds and levels of private services there are in which the public has an overriding interest-such that some sort of public investment is appropriate.

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