Analysis of variation in charges and prices paid for vaginal and caesarean section births: a cross-sectional study

Hsia, Renee Y.; Antwi, Yaa Akosa; Weber, Ellerie

doi:10.1136/bmjopen-2013-004017

Cited by 52 publications

(28 citation statements)

References 27 publications

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“…Those babies spent an average of 4.6 additional days in the hospital (7.7 vs. 3.1). The costs of this additional care are difficult to estimate, because charges vary across institutions (Hsia et al 2014). Nonetheless, the March of Dimes estimates that four days of SCN care cost approximately $30,000 (March of Dimes 2011).…”

Section: Discussionmentioning

confidence: 99%

Mothers’ childhood hardship forecasts adverse pregnancy outcomes: Role of inflammatory, lifestyle, and psychosocial pathways

Miller¹,

Culhane

Grobman³

et al. 2017

Brain, Behavior, and Immunity

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Research suggests the health consequences of economic hardship can be transmitted across generations. Some of these disparities are thought to be passed to offspring during gestation. But this hypothesis has not been tested in contemporary American samples, and the mechanisms of transmission have not been characterized. Accordingly, this study had two goals: first, to determine if women exposed to economic hardship during childhood showed higher rates of adverse birth outcomes; and second, to evaluate the contribution of inflammation, psychosocial, lifestyle, and obstetric characteristics to this phenomenon. This prospective study enrolled 744 women with singleton pregnancies (59.1% White; 16.3% Black; 18.7% Latina; 5.9% Other). Childhood economic hardship was measured by self-report. Birth outcomes included length of gestation and incidence of preterm birth; birth weight percentile and small for gestational age; length of hospital stay and admission to Special Care Nursery. Analyses revealed that mothers’ childhood economic hardship was independently associated with multiple adverse birth outcomes, even following adjustment for demographics, maternal education, and obstetrical confounders. Women raised in economically disadvantaged conditions had shorter gestation length and higher preterm delivery rates. Their babies had lower birth weights, were more likely to be small for gestational age, stayed in the hospital longer, and had more Special Care Nursery admissions. Mediation analyses suggested these associations arose through multiple pathways, and highlighted roles for inflammation, education, adiposity, and obstetric complications. Collectively, these findings suggest that childhood economic hardship predisposes women to adverse birth outcomes, and highlights likely behavioral and biological mechanisms.

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Section: Discussionmentioning

confidence: 99%

Mothers’ childhood hardship forecasts adverse pregnancy outcomes: Role of inflammatory, lifestyle, and psychosocial pathways

Miller¹,

Culhane

Grobman³

et al. 2017

Brain, Behavior, and Immunity

View full text Add to dashboard Cite

show abstract

“…15 56 While the public healthcare costs are reaching unsustainable levels, hospital charges can have alarming effects on patients. 56 In addition, the potential negative clinical effects of CS on mothers and newborns have raised concerns among clinicians, academics and policymakers alike. 15 Recent studies and their media coverage and associated increase in public awareness of high CS rates and changes in reimbursement policy have led to recent decreases of CS rates.…”

Section: Mechanismsmentioning

confidence: 99%

Caesarean sections and private insurance: systematic review and meta-analysis

Hoxha

Syrogiannouli

Braha³

et al. 2017

BMJ Open

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ObjectiveFinancial incentives associated with private insurance may encourage healthcare providers to perform more caesarean sections. We therefore sought to determine the association of private insurance and odds of caesarean section.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase and The Cochrane Library from the first year of records through August 2016.Eligibility criteriaWe included studies that reported data to allow the calculation of OR of caesarean section of privately insured as compared with publicly insured women.OutcomesThe prespecified primary outcome was the adjusted OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. The prespecified secondary outcome was the crude OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance.ResultsEighteen articles describing 21 separate studies in 12.9 million women were included in this study. In a meta-analysis of 13 studies, the adjusted odds of delivery by caesarean section was 1.13 higher among privately insured women as compared with women with public insurance coverage (95% CI 1.07 to 1.18) with no relevant heterogeneity between studies (τ2=0.006). The meta-analysis of crude estimates from 12 studies revealed a somewhat more pronounced association (pooled OR 1.35, 95% CI 1.27 to 1.44) with no relevant heterogeneity between studies (τ2=0.011).ConclusionsCaesarean sections are more likely to be performed in privately insured women as compared with women using public health insurance coverage. Although this effect is small on average and variable in its magnitude, it is present in all analyses we performed.

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“…Second, we identified several factors that contributed to a considerable proportion of hospital variation in cost, including hospital type of ownership, teaching/urban–rural status, neonatal care capacity and geographic region. This finding is consistent with previous evidence that type of ownership helped to explain hospital variation in costs or charges of maternity stay and presence of a separate neonatology unit contributed to hospital differences in cost of obstetric hospitalisations . These institutional characteristics help to inform future targeted efforts in cost containment and highlight areas for additional research.…”

Section: Discussionmentioning

confidence: 99%

“…17 NTSV births have been widely used in benchmarking hospital performance. 17 We excluded hospitals with fewer than 100 births per year (to focus on routine delivery hospitals and assure stable estimation of hospital performance), 3,18,19 Kaiser Permanente hospitals that were not required to provide financial data as a managed care organisation, 20 births with missing or extreme values on hospital cost or maternal/fetal clinical risk factors, and births where the mother or infant was transferred after delivery (as cost of subsequent hospitalisations was not always available) (see Figure S1). Our final analytical sample included 405 908 NTSV births from 220 hospitals, reflecting 83.4% of all NTSV births in the state and 84.0% of all delivery hospitals.…”

Section: Study Populationmentioning

confidence: 99%

Hospital variation in cost of childbirth and contributing factors: a cross‐sectional study

Lee

Lin

et al. 2017

BJOG

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Analysis of variation in charges and prices paid for vaginal and caesarean section births: a cross-sectional study

Cited by 52 publications

References 27 publications

Mothers’ childhood hardship forecasts adverse pregnancy outcomes: Role of inflammatory, lifestyle, and psychosocial pathways

Mothers’ childhood hardship forecasts adverse pregnancy outcomes: Role of inflammatory, lifestyle, and psychosocial pathways

Caesarean sections and private insurance: systematic review and meta-analysis

Hospital variation in cost of childbirth and contributing factors: a cross‐sectional study

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