Short Takes On News & Events

C-Section Delivery Rates Vary Widely Across Nation

By Alvin Tran

March 4th, 2013, 4:21 PM

Rates of C-section deliveries vary widely across the nation, according to the findings of a new study.

The study, published Monday in the journal Health Affairs, found that the overall rates of C-sections — the most common type of surgery in the U.S. — varied from about 7 to 70 percent  across the nation’s hospitals.

Researchers also found a wide variation in C-section deliveries even among women with lower-risk pregnancies, where rates varied from 2.4 to 36.5 percent. According to the study, cesarean deliveries are much more expensive than vaginal births.

“We were really surprised by how much variation we saw,” said Dr. Katy Kozhimannil, an assistant professor at the University of Minnesota’s School of Public Health and the study’s lead author. Kozhimannil said she and her colleagues expected the rates of cesarean births among lower-risk mothers to vary less compared to the overall rates.

The research team analyzed 2009 data from more than 1,000 hospitals in 44 states, taking patient characteristics into account as well as hospitals’ size, teaching status and geographic location.

The study’s findings suggest that small and rural hospitals showed more variability in C-section rates compared to other hospitals. Teaching hospitals, however, showed less variation in overall C-section rates.

Despite concerns about overuse of cesarean deliveries, Kozhimannil cautioned that some of these surgeries will always be necessary and researchers should be careful to not make doctors too uncomfortable about performing a cesarean. “When you see variation in something, it could suggest overuse or either underuse. I think it’s important to look out for underuse as well,” Kozhimannil added. “Cesarean deliveries save lives and every woman who needs a cesarean delivery should have one.”

Dr. William Grobman, a spokesman for the American College of Obstetricians and Gynecologists and a professor in obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University, said that it is important to “encourage deliveries that can be safely undertaken vaginally to occur and not to do unnecessary cesareans.”

In an interview, Grobman said the high number of cesarean deliveries has big consequences for health care costs and use and doctors consider different standards when weighing the procedure.

Though her study was unable to explain why the variation in cesarean deliveries exists, Kozhimannil is optimistic that future research — studies that analyze the financial and payment incentives in place for managing pregnancy care — may help answer the question.

“I think it is important to look beyond the woman and her characteristics and beyond the clinicians and their characteristics and really look at the system-level factors that are driving these variability and patterns in care,” she said.

The study makes four key recommendations, including better coordination among providers of maternity care to help reduce the need for C-sections and better data collection on the procedure. The researchers also called for Medicaid, which funds nearly half of all U.S. births, to use its clout to help improve hospital obstetric practices. And they suggested that new policies be implemented to empwer patients to help make decisions on their deliveries and to make data on the procedure more widely available.

“I think the fact that pregnant women cannot look up unbiased, easily available information on cesarean delivery rates in the hospitals from which they’re choosing is a problem that should be rectified,” Kozhimannil said.

4 Responses to “C-Section Delivery Rates Vary Widely Across Nation”

  1. wayne says:

    The definition of the word “shyster” is a person who uses unscrupulous, fraudulent, or deceptive methods in business. Shysters! The entire medical industry is filled with corrupt and worthless shysters!

  2. sencha says:

    Each of the over 6,000 acute care, short term hospitals in the US did and may still practice a monthly or quarterly review of all their formal prices listed on their hospital specific specific Charge Master.
    A complex computer software system routinely carries out a price sensitivity review to identify where prices should be adjusted up or down to maximize the hospital’s net revenue. Because the payor mix of each hospital as well as the volume of procedures and tests vary between and among all hospitals and because on a year to year basis these case mix volume and payer contract mix factors will actually shift within the same hospital, it is a prudent business practice to adjust prices frequently through out the hospital’s year to optimize net revenue. Some federal and state government rules hold specific rates of reimbursement constant, but where ever the hospital is not prevented from adjusting prices it forges ahead to optimize net revenue. Short of nationalizing the hospitals’ pricing practices we are in for wide and unexplained price variation.

  3. Bob says:

    Sencha, did you even READ the story? It is not about pricing, sigh.

    The C-section rates are absurd and hospitals should definitely be able to keep C-section rates below 10%.

  4. Margaret Beck says:

    In 1989 the software program SMALL AREA ANALYSIS out of Dartmouth was used by my health care coalition and identified 12 surgical interventions that were off the charts in our area. Unfortunately it took over 10 years for the heart procedures to finally be investigated, resulting in one of the largest fines ever paid by a hospital. The C-section rate was another issue as were hysterectomies. One provider joked that if there was a woman over 40 in our area wit her uterus, she must be a tourist.

    Seriously, these issues need to be address in the context of quality of care as well as cost. MORE medicine is not better medicine. The US should be ready to hear that message when we are spending 18% of GDP on health care.