Geographic variation in cesarean delivery in the United States by payer

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• 作者：Rachel Mosher Henke (1)
  Lauren M Wier (1)
  William D Marder (1)
  Bernard S Friedman (2)
  Herbert S Wong (2)
  
  1. Truven Health Analytics ; 150 Cambridge Park Drive ; Cambridge ; MA ; 02140 ; USA
  2. U.S. Agency for Healthcare Research and Quality ; 540 Gaither Road ; Rockville ; MD ; 20850 ; USA
  
• 关键词：Cesarean delivery rate ; Geographic variation ; Medicaid ; Private insurance
• 刊名：BMC Pregnancy and Childbirth
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：758 KB
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• 刊物主题：Reproductive Medicine; Maternal and Child Health; Gynecology;
• 出版者：BioMed Central
• ISSN：1471-2393

文摘

Background The rate of cesarean delivery in the United States is variable across geographic areas. The aims of this study are two-fold: (1) to determine whether the geographic variation in cesarean delivery rate is consistent for private insurance and Medicaid (2) to identify the patient, population, and market factors associated with cesarean rate and determine if these factors vary by payer. Methods We used the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) to measure the cesarean rate at the Core-Based Statistical Area (CBSA) level. We linked the hospitalization data to data from other national sources to measure population and market characteristics. We calculated unadjusted and risk-adjusted CBSA cesarean rates by payer. For the second aim, we estimated a hierarchical logistical model with the hospitalization as the unit of analysis to determine the factors associated with cesarean delivery. Results The average CBSA cesarean rate for women with private insurance was higher (18.9 percent) than for women with Medicaid (16.4 percent). The factors predicting cesarean rate were largely consistent across payers, with the following exceptions: women under age 18 had a greater likelihood of cesarean section if they had Medicaid but had a greater likelihood of vaginal birth if they had private insurance; Asian and Native American women with private insurance had a greater likelihood of cesarean section but Asian and Native American women with Medicaid had a greater likelihood of vaginal birth. The percent African American in the population predicted increased cesarean rates for private insurance only; the number of acute care beds per capita predicted increased cesarean rate for women with Medicaid but not women with private insurance. Further we found the number of obstetricians/gynecologists per capita predicted increased cesarean rate for women with private insurance only, and the number of midwives per capita predicted increased vaginal birth rate for women with private insurance only. Conclusions Factors associated with geographic variation in cesarean delivery, a frequent and high-resource inpatient procedure, vary somewhat by payer. Using this information to identify areas for intervention is key to improving quality of care and reducing healthcare costs.