From 2013 to 2014, California hospitals reduced the number of statewide caesarean deliveries by over 1,000, according the Los Angeles Times.
Experts in the medical community have asserted for years that C-section rates were too high, but still the numbers continued to climb. In California, in what is perhaps reflective of a trend poised to spread nationwide, the rate is dropping substantially.
Here are six major takeaways from the LA Times article.
1. According to the LA Times, U.S. physicians began leaning more heavily on the C-section out of convenience because the procedure is much quicker than natural birth. Prior to the Affordable Care Act, the fee-for-service system also offered plenty of fiscal incentive for physicians to perform this procedure. Now hospitals are under pressure to change the culture.
2. The World Health Organization defines the ideal C-section rate as being around 15 percent. In 2009, C-section rates reached their national peak — the rate was over 32 percent, according to the LA Times. The U.S. surgeon general has called for reducing the low-risk C-section rate to 23.9 percent by 2020.
3. A vaginal delivery accompanied with maternal care costs commercial insures $15,259 on average in the state of California. For a C-section and maternal care, that number jumps to $21,307. Katy Kozhimannil, PhD, a health policy professor at the University of Minnesota in Minneapolis, said in the LA Times when insurers and self-insured employers "look at where their costs are going, you start to see caesarean delivery rises to the top."
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4. While hospitals face direct pressure from insurers to reduce C-section rates, they also have their own concerns about how a high rate could adversely influence patient volumes. Medical data is becoming increasingly available to patients, and hospitals don't want to fall behind and lose patients who look unfavorably upon high C-section rates, according to the LA Times.
5. Some California hospitals have suffered revenue hits attributable to the reduction of the procedure. Providence Health & Services hospitals in Southern California absorbed such a revenue hit. They also had to spend new money on hiring obstetricians so the delivery wards could be staffed in shifts, thereby reducing pressure on physicians to opt for C-sections because they feel rushed. In the face of these fiscal challenges, Providence Health's Regional CMO Michael Bernstein, MD, told the LA Times the reduction is good for patients and will ultimately benefit the hospital group down the line.
6. While most obstetricians agree that C-section rates are too high, there is worry that an overly concerted effort to reduce rates could ultimately harm women. Aaron Caughy, MD, chair of the Department of Obstetrics and Gynecology at Oregon Health & Science University School of Medicine in Portland, believes there should not be an exact target C-section rate for all hospitals due to patient population differences. In the LA Times, Dr. Caughy said, "I would hate it if Medicaid said, 'Every hospital whose rate is above the median, we're not going to pay you a chunk of money.' That is a bad approach because then people squeeze it down without attention to what's best for patients."
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