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Geographic variation in cesarean delivery in the United States by payer

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, populatio...

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Autores principales: Henke, Rachel Mosher, Wier, Lauren M, Marder, William D, Friedman, Bernard S, Wong, Herbert S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241225/
https://www.ncbi.nlm.nih.gov/pubmed/25406813
http://dx.doi.org/10.1186/s12884-014-0387-x
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author Henke, Rachel Mosher
Wier, Lauren M
Marder, William D
Friedman, Bernard S
Wong, Herbert S
author_facet Henke, Rachel Mosher
Wier, Lauren M
Marder, William D
Friedman, Bernard S
Wong, Herbert S
author_sort Henke, Rachel Mosher
collection PubMed
description 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.
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spelling pubmed-42412252014-11-24 Geographic variation in cesarean delivery in the United States by payer Henke, Rachel Mosher Wier, Lauren M Marder, William D Friedman, Bernard S Wong, Herbert S BMC Pregnancy Childbirth Research Article 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. BioMed Central 2014-11-19 /pmc/articles/PMC4241225/ /pubmed/25406813 http://dx.doi.org/10.1186/s12884-014-0387-x Text en © Henke et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Henke, Rachel Mosher
Wier, Lauren M
Marder, William D
Friedman, Bernard S
Wong, Herbert S
Geographic variation in cesarean delivery in the United States by payer
title Geographic variation in cesarean delivery in the United States by payer
title_full Geographic variation in cesarean delivery in the United States by payer
title_fullStr Geographic variation in cesarean delivery in the United States by payer
title_full_unstemmed Geographic variation in cesarean delivery in the United States by payer
title_short Geographic variation in cesarean delivery in the United States by payer
title_sort geographic variation in cesarean delivery in the united states by payer
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241225/
https://www.ncbi.nlm.nih.gov/pubmed/25406813
http://dx.doi.org/10.1186/s12884-014-0387-x
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