Anthem Blue Cross & Blue Shield's new multi-year pacts to pay Ob/Gyn doctors higher rates begin to address part of the complex costs squeeze that's been driving medical specialists out of Greater Cincinnati.

Most of this region's 200 specialists in obstetrics and gynecology agreed to contracts with Anthem that run through 2005. Most will see reimbursement rates rise from below Medicare rates to slightly higher than Medicare rates. Ob/Gyns here have seen insurer reimbursements plummet while costs for malpractice insurance have soared. Anthem's multi-year deals, announced Thursday, were the result of negotiations lasting from December to May. Insurers, employers and doctors worked out terms they all could live with. It's a formula that could serve as a model for other insurers to give some relief to specialists.

Anthem is among the first in town to move the needle. After a decade of pushing for more controls on runaway health care costs, employers here are still cautious about relaxing those restraints now. But no one wants to see further erosion in the Tristate's line-up of specialists or to hasten the day when we are forced to go shopping out-of-town for a baby doctor, a neurosurgeon or heart specialist. Multi-year deals give stable, predictable rates that everyone, including employers, can count on.

Other pieces of this health care crisis still need fixing. Many specialists still face stiff malpractice insurance premiums. Dr. James Wendel of Mount Auburn Ob/Gyn Associates says a year's malpractice coverage in 1999 cost him $19,000. This year, it's $58,000. Solutions may require dealing with malpractice insurance rates and jury awards. Ohio lawmakers already are proposing follow-up legislation to SB 281, passed in December to cap non-economic damages in malpractice lawsuits at $500,000.

Ob/Gyn specialists here partly credit their agreements with Anthem to new bargaining power from joining a union. They got help during negotiations from consultants with the Federation of Physicians and Dentists. The union last year enlisted about 85 percent of local Ob/Gyn specialists.

The docs view Anthem deals as a big first step. So do we. All parties need to be at the table to make sure more of the same will follow.