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Economic Considerations in Cesarean Section Use

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Cesarean Section

Part of the book series: Clinical Perspectives in Obstetrics and Gynecology ((CPOG))

Abstract

Cesarean section was originally indicated to preserve the life of a mother with obstructed labor or to deliver a viable infant from a mother who was dying.1 Although now in widespread use in less dire situations, the operative approach to delivery is associated with significantly greater economic costs compared with vaginal delivery. The increased cost of cesarean section is related both to higher delivery charges and the costs of maternal and neonatal morbidity and mortality. In a health care policy environment that increasingly emphasizes cost effectiveness and cost containment, high rates of use of expensive health care technologies such as cesarean section must be justified by improvements in outcome that are worth their cost.

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References

  1. Dunn LJ. Cesarean section and other obstetric operations. In: Scott JR, DiSaia PJ, Hammond CB, Spellacy WN, eds. Danforth’s Obstetrics and Gynecology, 6th Ed. Philadelphia: Lippincott, 1990:639–658.

    Google Scholar 

  2. Elixhauser A, Andrews RM, Fox S. Clinical classifications for health policy research: discharge statistics by principal diagnosis and procedure. AHCPR Publication No. 93–0043. Division of Provider Studies Research Note 17, Agency for Health Care Policy and Research. Rockville, Maryland: Public Health Service, 1993.

    Google Scholar 

  3. Taffei SM, Placek PJ. An overview of recent patterns in cesarean delivery and where we stand today. Presented at the 116th Annual Meeting of the American Public Health Association, November 13–17, 1988, Boston, Massachusetts.

    Google Scholar 

  4. Porreco RP. High cesarean section rate: a new perspective. Obstet Gynecol 1985;65(3):307–311.

    PubMed  CAS  Google Scholar 

  5. de Regt RH, Minkoff HL, Feldman J, Schwarz RH. Relation of private or clinical care to cesarean birth rate. N Engl J Med 1986;315:619–624.

    Article  PubMed  Google Scholar 

  6. Petitti DB. The ideal cesarean section rate. In: Parer JT, ed. Antepartum and intrapartum management. Philadelphia: Lea & Febiger, 1989:207–215.

    Google Scholar 

  7. Evrard JR, Gold EM. Cesarean section and maternal mortality in Rhode Island. Obstet Gynecol 1977;50:594.

    PubMed  CAS  Google Scholar 

  8. Minkoff HL, Schwarz RH. The rising cesarean section rate: can it safely be reversed? J Am Coll Obstet Gynecol 1980;56(2):135–143.

    CAS  Google Scholar 

  9. Rubin GL, Peterson HB, Rochat RW, et al. Maternal death after cesarean section in Georgia. Am J Obstet Gynecol 1981;139:681.

    PubMed  CAS  Google Scholar 

  10. Petitti DB, Cefalo RC, Shapiro S, et al. In hospital maternal mortality in the United States: time trends and relation to method of delivery. Obstet Gynecol 1982;59:6–12.

    PubMed  CAS  Google Scholar 

  11. Rochat RW, Koonin LM, Atrash HK, Jewett JF. Maternal mortality in the United States: report from the Maternal Mortality Collaborative. Obstet Gynecol 1988;72(l):91–97.

    PubMed  CAS  Google Scholar 

  12. Guldholt I, Espersen T. Maternal febrile morbidity after cesarean section. Acta Obstet Gynecol Scand 1987;66:675–679.

    Article  PubMed  CAS  Google Scholar 

  13. Tulman L, Fawcett J. Return of functional ability after childbirth. Nurs Res 1988;37:77–81.

    PubMed  CAS  Google Scholar 

  14. NIH. Cesarean childbirth: report of the NICHD task force on cesarean childbirth. Bethesda, MD: National Institutes of Health,1981. (DHHS publication no. (NIH) 82–2067.)

    Google Scholar 

  15. Bland R. Pathogenesis of pulmonary edema after premature birth. Adv Pediatr 1987;34:175–221.

    PubMed  CAS  Google Scholar 

  16. Martin DP, Fadden MK, Holt VL, et al. The relationship among delivery method, quality and outcomes of obstetrical care. Presented at the annual meeting of the Association for Health Services Research, 1992, Chicago, Illinois.

    Google Scholar 

  17. Finkler MD, Wirtschafter DD. Why pay extra for cesarean deliveries? Inquiry 1993;30(2):208–215.

    PubMed  CAS  Google Scholar 

  18. Hack M, Fanaroff AA. Outcomes of extre-mely-low-birth-weight infants between 1982 and 1988. N Engl J Med 1989;321(24):1642–1647.

    Article  PubMed  CAS  Google Scholar 

  19. Anderson GM, Lomas J. Explaining variations in cesarean section rates: patients, facilities or policies? Can Med Assoc J 1985; 132:253–259.

    PubMed  CAS  Google Scholar 

  20. Carpenter MW, Soule D, Yates WT, Meeker CI. Practice environment is associated with obstetric decision making regarding abnormal labor. Obstet Gynecol 1987;70:657–662.

    PubMed  CAS  Google Scholar 

  21. Fraser W, Usher RH, McLean FH, et al. Temporal variation in rates of cesarean section for dystocia: does “convenience” play a role? Am J Obstet Gynecol 1987;156:300–304.

    PubMed  CAS  Google Scholar 

  22. Gardner LB. Hospital-physician relationships and cesarean section rate variations. Doctoral dissertation, University of California at Berkeley.

    Google Scholar 

  23. Evans R. Supplier-induced demand: some empirical evidence and implications. In: Perlman M, ed. The economics of health and medical care. New York: Wiley, 1974.

    Google Scholar 

  24. Anderson R, House D, Ormiston M. A theory of physician behavior with supplier-induced demand. South Econ J 1981;July:124–133.

    Google Scholar 

  25. Wilensky GR, Rossiter LF. The relative importance of physician-induced demand in the demand for medical care. Milbank Mem Fund Q 1983;61(2):252–277.

    Article  CAS  Google Scholar 

  26. Luft HS. Economic incentives and constraints in clinical practice. In: Aiken LH, Mechanic D, eds. Applications of social science to clinical medicine and social policy. New Brunswick: Rutgers University Press,1986:500–518.

    Google Scholar 

  27. Tussing AD, Wojtowycz MA. The cesarean decision in New York State, 1986. Med Care 1992;30(6):529–540.

    Article  PubMed  CAS  Google Scholar 

  28. Robinson JC, Gardner LB, Luft HS. Health plan switching in anticipation of increased medical care utilization. Med Care 1992;31(1):43–51.

    Article  Google Scholar 

  29. Murray D. Do you know how much to charge? Medical Economics 1993 October 11:106–133.

    Google Scholar 

  30. Pauly MV, Hillman AL, Kerstein J. Managing physician incentives in managed care. Med Care 1990;28:1013–1024.

    Article  PubMed  CAS  Google Scholar 

  31. Wilner S, Schoenbaum SC, Monson RR, Winickoff RN. A comparison of the quality of maternity care between a health maintenance organization and fee for service practices. N Engl J Med 1981;304:784–787.

    Article  PubMed  CAS  Google Scholar 

  32. Wright CH, Gardin TH, Wright CL. Obstetric care in a health maintenance organization and a private fee-for-service practice: a comparative analysis. Am J Obstet Gynecol 1984;149:848–856.

    PubMed  CAS  Google Scholar 

  33. McCloskey L, Petitti DB, Hobel CJ. Variations in the use of cesarean delivery for dystocia. Lessons about the source of care. Med Care 1992;30:126–135.

    Article  PubMed  CAS  Google Scholar 

  34. Stafford RS, Sullivan SD, Gardner LB. Trends in cesarean section use in California, 1983–90. Am J Obstet Gynecol 1993;168(4):1297–1302.

    PubMed  CAS  Google Scholar 

  35. Hillman AL. Health maintenance organizations, financial incentives, and physicians’ judgments. (Editorial.) Ann Intern Med 1990;112(12):891–893.

    PubMed  CAS  Google Scholar 

  36. Feldman GB, Freiman JA. Prophylactic cesarean section at term? N Engl J Med 1985;312(19):1264–1267.

    Article  PubMed  CAS  Google Scholar 

  37. Cepicky P, Stembra Z, Zeman J, Lomickova T, Mandys F. When is it possible to meet the wish of a woman to terminate her labour by cesarean section? Eur J Obstet Gynecol Reprod Biol 1990;38:109–112.

    Article  Google Scholar 

  38. Rock SM. Malpractice premiums and primary cesarean section rates in New York and Illinois. Public Health Rep 1988;103:459–463.

    PubMed  CAS  Google Scholar 

  39. McCullough LB. The physician’s virtues and legitimate self-interest in the patient-physician contract. Mt Sinai J Med 1993;60(1):11–14.

    PubMed  CAS  Google Scholar 

  40. Feldstein PJ. Health care economics, 3rd Ed. Albany: Delmar, 1988.

    Google Scholar 

  41. Redelmeier DA, Tversky A. Discrepancy between medical decisions» for individual patients and for groups. N Engl J Med 1990; 322(16):1162–1164.

    Article  PubMed  CAS  Google Scholar 

  42. Shy KK, LoGerfo JP, Karp LE. Evaluation of elective repeat cesarean section as a standard of care: an application of decision analysis. Am J Obstet Gynecol 1981;139(2):123–129.

    PubMed  CAS  Google Scholar 

  43. Silver RK, Minogue J. When does a statistical fact become an ethical imperative?Am J Obstet Gynecol 1987;157(2):229–233.

    PubMed  CAS  Google Scholar 

  44. Davies LM, Drummond MF. Management of labour: Consumer choice and cost implications. Journal of Obstetrics and Gynecology 1991;11[Suppl. 1]:S28–S33.

    Article  Google Scholar 

  45. American College of Obstetrics and Gynecology. Guidelines for Vaginal Delivery after a Previous Cesarean Birth. Washington, DC: Committee on Obstetrics: Maternal and Fetal Medicine, 1988.

    Google Scholar 

  46. Luce BR, Elixhauser A. Standards for the socioeconomic evaluation of health care services. Berlin: Springer-Verlag, 1990.

    Google Scholar 

  47. Green JE, McLean F, Smith LP, Usher R. Has an increased cesarean section rate for term breech delivery reduced the incidence of birth asphyxia, trauma, and death? Am J Obstet Gynecol 1982;142:643–649.

    PubMed  CAS  Google Scholar 

  48. Myers SA, Gleicher N. Breech delivery: why the dilemma? Am J Obstet Gynecol 1987;156(1):6–10.

    PubMed  CAS  Google Scholar 

  49. Cruikshank DP. Malpresentations and umbilical cord complications. In: Scott JR, DiSaia PJ, Hammond CB, Spellacy WN, eds. Danforth’s Obstetrics and Gynecology, 6th Ed. Philadelphia: Lippincott, 1990:567–584.

    Google Scholar 

  50. Danforth DN. Cesarean section. JAMA 1985;253(6):811–818.

    Article  PubMed  CAS  Google Scholar 

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© 1995 Springer-Verlag New York, Inc.

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Gardner, L.B. (1995). Economic Considerations in Cesarean Section Use. In: Flamm, B.L., Quilligan, E.J. (eds) Cesarean Section. Clinical Perspectives in Obstetrics and Gynecology. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2482-2_13

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  • DOI: https://doi.org/10.1007/978-1-4612-2482-2_13

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7556-5

  • Online ISBN: 978-1-4612-2482-2

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