With less funds, hospitals cut down on C-sections

Cost-cutting measures associated with managed care have reduced the number of Caesarean sections performed in Pennsylvania, according to a recent report. The C-section operation, which involves removing the infant through an incision the walls of the uterus, is the most commonly performed surgical procedure in the state, accounting for $209 million in medical costs in 1995. After rising from 5 percent of the total amount of deliveries in 1970 to 25 percent in 1987, Pennsylvania's C-section rate fell to 20.2 percent in 1995, saving patients and insurers an estimated $20 million annually. The report, which was issued by the Pennsylvania Health Care Cost Containment Council, also found that 20.7 percent of the babies born at the Hospital of the University of Pennsylvania in 1995 were delivered by C-section. The C-section rates at the 41 hospitals surveyed in the Philadelphia region ranged from 28.5 percent of the total deliveries at Jeanes Hospital to 11.2 percent at Episcopal Hospital. Mark Woodland, a professor of Obstetrics and Gynecology at Pennsylvania Hospital, said the report shows "the pendulum swung out and is now swinging back again." If the decrease continues, C-section rates at HUP and across the state should reach the 15 percent target rate set by the U.S. Department of Health and Human Services by the year 2000. Experts agree that an excessive number of unnecessary C-sections were performed in the 1980s. Albert Reese, chairperson of Temple University's obstetrics and gynecology department, attributed this high C-section rate to doctors' fear of being sued. "There is that lurking misconception that if you're concerned about anything, the best thing to do is get the baby out," he explained. But this overreliance on C-sections proved problematic because of the risks associated with the procedure and the possibility of scars rupturing during subsequent normal births. C-sections also cost patients an average of $7,300, as opposed to $3,700 for normal births. Additionally, the procedure requires patients to remain in the hospital for twice as long as after a normal delivery, adding to the cost of the operation. Experts attributed the reduced number of C-sections to several factors, including active discouragement of the procedure by managed care insurers. Many insurance companies, such as Aetna U.S. Healthcare -- which manages the University's student health plan -- have adopted formulas which pay doctors more to perform normal deliveries than C-sections. Patients enrolled by Medicaid health maintenance organizations have a C-section rate of 17.2 percent, considerably below the state average. Phillip Goldstein, regional director of Oxford Health Plans, said many of the 75,000 people enrolled in Oxford's local Medicaid plan live in urban areas with teaching hospitals that encourage normal births. These patients also tend to use midwives, who rarely refer them to hospitals for C-sections. And Goldstein said the lower average age of Medicaid mothers may lead to fewer complications requiring a C-section delivery.

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