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Cesarean section use and source of payment: An analysis of California hospital discharge abstracts

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  • Stafford, R.S.

Abstract

This study assessed the relation between payment source and cesarean section use by analyzing California data on hospital deliveries. Of 461,066 deliveries in 1986, cesarean sections were performed in 24.4 percent. Women with private insurance had the highest cesarean section rates (29.1 percent). Successively lower rates were observed for women covered by non-Kaiser health maintenance organizations (26.8 percent), Medi-Cal (22.9 percent), Kaiser (19.7 percent), self-pay (19.3 percent), and Indigent Services (15.6 percent). Vaginal birth after cesarean (VBAC) occurred more than twice as frequently in women covered by Kaiser (19.9 percent) and Indigent Services (24.8 percent), compared to those with private insurance (8.1 percent). Sizable, although less pronounced, associations between payment source and cesarean section use were noted for the indications of breech presentation, dystocia, and fetal distress. Accounting for maternal age and race/ethnicity did not alter these findings. Variations in the use of cesarean section have a substantial financial impact on health care payors.

Suggested Citation

  • Stafford, R.S., 1990. "Cesarean section use and source of payment: An analysis of California hospital discharge abstracts," American Journal of Public Health, American Public Health Association, vol. 80(3), pages 313-315.
    • Handle: RePEc:aph:ajpbhl:1990:80:3:313-315_1
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    Cited by:

    1. Eckerlund, Ingemar & Gerdtham, Ulf-G, 1996. "Variation in cesarean section rates in Sweden - Causes and economic consequences," SSE/EFI Working Paper Series in Economics and Finance 106, Stockholm School of Economics.
    2. Shen, Menghan & Li, Linyan, 2020. "Differences in Cesarean section rates by fetal sex among Chinese women in the United States: Does Chinese culture play a role?," Economics & Human Biology, Elsevier, vol. 36(C).
    3. Leo Turcotte & John Robst & Solomon Polachek, 2006. "Medical interventions among pregnant women in fee-for-service and managed care insurance: a propensity score analysis," Applied Economics, Taylor & Francis Journals, vol. 38(13), pages 1513-1525.
    4. Lo, Joan C., 2008. "Financial incentives do not always work--An example of cesarean sections in Taiwan," Health Policy, Elsevier, vol. 88(1), pages 121-129, October.
    5. David Meltzer & Jeanette Chung, 2002. "Effects of Competition Under Prospective Payment on Hospital Costs Among High- and Low-Cost Admissions: Evidence from California, 1983 and 1993," NBER Chapters, in: Frontiers in Health Policy Research, Volume 5, pages 53-102, National Bureau of Economic Research, Inc.
    6. Hendrik Jürges, 2007. "Health Insurance Status and Physician-Induced Demand for Medical Services in Germany: New Evidence from Combined District and Individual Level Data," SOEPpapers on Multidisciplinary Panel Data Research 8, DIW Berlin, The German Socio-Economic Panel (SOEP).
    7. Stoddard Christiana & Stock Wendy A. & Hogenson Elise, 2016. "The Impact of Maternity Leave Laws on Cesarean Delivery," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 16(1), pages 321-364, January.
    8. Jostein Grytten & Irene Skau & Rune Sørensen, 2013. "Do Mothers Decide? The Impact of Preferences in Healthcare," Journal of Human Resources, University of Wisconsin Press, vol. 48(1), pages 142-168.
    9. Sloan, Frank A. & Entman, Stephen S. & Reilly, Bridget A. & Glass, Cheryl A. & Hickson, Gerald B. & Zhang, Harold H., 1997. "Tort liability and obstetricians' care levels," International Review of Law and Economics, Elsevier, vol. 17(2), pages 245-260, June.
    10. Grytten, Jostein & Skau, Irene & Sørensen, Rune, 2011. "Do expert patients get better treatment than others? Agency discrimination and statistical discrimination in obstetrics," Journal of Health Economics, Elsevier, vol. 30(1), pages 163-180, January.
    11. Manuel Adelino & Katharina Lewellen & W. Ben McCartney, 2022. "Hospital Financial Health and Clinical Choices: Evidence from the Financial Crisis," Management Science, INFORMS, vol. 68(3), pages 2098-2119, March.

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