Cover Story - October 2006
In 1997, a
article asked, "Is Adam Worth More Than Eve?" The answer, according
to Austin obstetrician-gynecologist Margaret Thompson, MD, is
unfortunately "yes." She has personal experience to prove it.
In February 2001, the 24-bed Renaissance Women's Center of
Austin closed its doors, and Universal Health Services (UHS), the
national company that financed the hospital, announced it would
also abandon plans to create a chain of specialty women's
The closure was a defeat for Austin's Renaissance Women's Group,
whose offices were housed on the hospital's second floor. The
10-physician group had sued UHS to keep the facility open, claiming
the chain was breeching its 15-year lease agreement with the
physicians. Because a jury awarded the group $6.9 million in
damages, a judge determined UHS could close the hospital's doors.
UHS appealed and in 2003, the Texas Supreme Court ruled the company
did not have to pay the damages. The Renaissance Women's Center
Dr. Thompson, then president and founder of the Renaissance
Women's Group, blames the hospital's closure primarily on low
reimbursements for obstetrics services. She says the patient load
was not the problem, as the hospital was often at capacity. Gender
discrimination in medical insurance payments proved its
"Even though Renaissance Women's Center was well received,
patients loved it, the community liked it, and we were at capacity
at all times, reimbursements for our obstetrics services were very
low," she said.
The Renaissance was not alone in experiencing poor
study concluded that "significant gender bias" in reimbursement
based on Medicare relative value units for female-specific services
leads to a lower net reimbursement for gynecologic procedures. The
study examined 24 matched procedures, such as biopsy of male and
female genitals, hysterectomy versus prostatectomy, and staging for
ovarian versus testicular cancer. Procedures on men were reimbursed
at a higher amount in 19 of the cases. The procedures on women paid
more in three cases, and there was no difference in reimbursement
for two of the procedures. Overall, the study showed, procedures on
men paid 44 percent higher than those on women.
A few months after the Renaissance Women's Center closed, the
Texas Legislature passed the Omnibus Women's Equal Health Care Act.
It bans gender discrimination in health insurance reimbursement.
Advocates for the bill pointed to Medicare payment formulas. Under
the formulas, an average of $2,000 was reimbursed for childbirth,
which included 13 to 15 office visits, labor, and postpartum care.
But removal of a nonruptured appendix, a one-hour surgery with two
follow-up visits, paid $1,400.
Although the bill passed and was cited as a victory for women's
health care, Dr. Thompson believes the system has a long way to
"Reimbursements have traditionally been and continue to be low
for obstetrics. Fifty years ago, obstetrics was not high-tech
intensive care. It was basic, very routine, low technology. That's
completely changed, but reimbursements for services have not caught
up with that development. Although the Omnibus Act addressed equal
payment for ailments affecting both men and women, it did not
address low reimbursements for services affecting only women," she
Robert Watson, MD, medical director of the new Paul and Judy
Andrews Women's Hospital being built by Baylor All Saints Medical
Center in Fort Worth, agrees with Dr. Thompson that reimbursement
for women's health care services is low. "I think that is a
disservice to the women of our country," he added.
The idea of a women's hospital is not new. During the19th
century, Elizabeth Blackwell, the first woman to graduate from
medical school, and other physicians were instrumental in creating
hospitals for women. Existing facilities did not admit or employ
women to their staffs. During this time, and for years afterward,
women's health was primarily equated with their roles as mothers;
there was little recognition that men and women have different
In the report,
A Century of Women's Health: 1900-2000
, the Office on Women's Health in the U.S. Department of Health and
Human Services said it took the better part of the 20th century for
medical researchers, practitioners, and policymakers to directly
address the issue of sex-based differences in the diagnosis and
treatment of disease.
"Throughout most of the century, medical research and practice
were based on an androcentric view of science. The male model was
the norm. Joined to this practice were fears regarding the effects
of clinical trials on women of childbearing age," it said.
The report cited tragedies linked to the use of
diethylstilbestrol and thalidomide in pregnant women in the 1950s
and 1960s, which led to regulations in the 1970s that restricted
testing of new treatments in women of reproductive age. This
ultimately led to widespread exclusion of women of all ages from
clinical trials and resulted in women continuing to use medical
treatments and techniques tested solely on men. It was not until
1990, when a General Accounting Office report brought to light the
under-representation of women in federally funded clinical trials,
that federal agencies changed their policies to include women in
More recent research has shown gender-based differences in
women's health care use and costs, the probability of them
receiving major therapeutic procedures in acute settings, and the
likelihood a woman will undergo a major diagnostic procedure.
Gender-linked differences in patient satisfaction and communication
with physicians also was shown.
Ironically, many of these factors are the very reason Stanley
Rogers, MD, Warren Jacobs, MD, and Jack Moore, MD, opened The
Woman's Hospital of Texas in Houston 30 years ago. They envisioned
a facility that catered to women's wants and health care needs.
Together with 25 other colleagues, they opened the hospital, now
the largest facility of its kind in the state. The Woman's Hospital
began allowing fathers in the delivery room and requiring them to
take childbirth classes, long before both practices were
"The reason we wanted to start the hospital is simple," said Dr.
Moore. "We cared about women's health and wanted to create a place
that provided the best possible care. Although I'm retired, my
heart is still tied to the place. It's where I delivered a lot of
young people into the world, and I'm proud to have watched the
hospital's services grow these last 30 years."
Reproductive endocrinologist Leah Schenk, MD, joined The Woman's
Hospital staff after her husband moved to Houston for medical
"Patients receive specialized health care from physicians and
staff who are very experienced with women's needs," she said. "A
woman can come here as a teenager and receive services through her
reproductive years, menopause, and beyond. Most medical needs a
woman has during her life can be addressed here."
The hospital eventually was acquired by Hospital Corporation of
America. It is affiliated with Baylor College of Medicine and The
University of Texas OB-Gyn programs and provides training for
residents. A $72.3 million expansion is scheduled to start by the
end of the year.
Not Women Only
When asked if women's hospitals specifically benefit women
physicians, Dr. Schenk replied, "I don't think women physicians,
but definitely women patients. Women I've treated like the concept
of a women's hospital. I live in the suburbs, about 45 minutes away
from the hospital. My neighbors, associates, mothers of children
that attend my kids' schools, many come to my partners for health
care. There are even some men who opt for services at Woman's. In
fact, a lot of the male physicians practicing here choose the
hospital for their own surgeries."
Last year, close to 7,000 surgical procedures unrelated to
childbirth were performed on women of all ages at The Woman's
Hospital. Surgeries included breast reconstruction, gallbladder
removal, hernia repair, and scar tissue removal.
Dr. Thompson thinks the hospital's expansion into these services
was the key to its success. Without that expansion, she believes,
Woman's might have had the same experience as that of Austin's
"We tried to add other procedures - plastic surgery,
general breast surgery - but the bulk of our business was
obstetrics and gynecology," she said. "I now believe the project
was doomed from the start. Any women's hospital that primarily
offers obstetrics simply can't make it financially."
Dr. Watson anticipates the new Baylor All Saints facility will
be successful because it is following the same path as The Woman's
Hospital in Houston and will not be limited to obstetrics.
Another hospital catering to women's health care needs is being
developed - the Women's Hospital at Renaissance in
Edinburg - and more could be on the way. "With the surge
in population, aging baby boomers, and medical advances, I predict
that more women's hospitals will be built because I am seeing
firsthand the demand for these comprehensive services," Dr. Watson
Both the Fort Worth and Edinburg hospitals plan to offer
traditional maternity services, as well as a wide range of
specialty services for diagnostics, screenings, and treatment.
"Hospital Within a Hospital"
Sometimes providing specialized women's services takes a little
ingenuity. The Renaissance Women's Center is history, but Austin
continues to have a women's health facility, even if it's not in
the traditional sense. Housed in the city-owned Brackenridge
Hospital, the Austin Women's Hospital often has been described as
"a hospital within a hospital."
The Catholic-affiliated Seton Healthcare Network began leasing
Brackenridge from the city in 1995 after years of financial
problems prompted city officials to look for ways to get the
expensive hospital operation off their books.
Although the original agreement between the city and Seton
allowed all reproductive health services, except for abortion, to
continue at Brackenridge, the Catholic Church eventually ordered
Seton to end the arrangement. Beginning in 2001, sterilizations and
other forms of birth control were no longer provided. Austin
physicians, activists, and women's rights organizations immediately
voiced their concerns that a lack of access to these services
harmed the reproductive rights of the women Brackenridge
A solution was crafted in which the city now funds the Austin
Women's Hospital, while The University of Texas Medical Branch at
Galveston operates it. The hospital is on the fifth floor of
Brackenridge Hospital and exists completely independent of Seton.
It has its own entrance and provides sterilizations and
contraception services, but not abortions. A patient must be
transferred to another hospital if a physician determines that an
abortion is medically necessary. Seton has agreed to refer women to
Austin Women's Hospital if the women request services the Seton
network does not provide.
Peggy Romberg, executive director of the Women's Health and
Family Planning Association of Texas, says creation of Austin
Women's Hospital is positive, but it's far from a perfect
"The compromise between the city and Seton was unusual, but not
the disagreement," she said. "Mergers like this occur all over the
United States. Religious networks impose their doctrine on health
care facilities, and women lose access to certain services.
Regarding women hospitals, it's troubling to think those existing
hospitals might have to stop certain services if they choose to
partner with a religious network, especially if that type of merger
is their only hope of remaining open."
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