Explaining Source of Payment Differences in U.S. Cesarean Rates: Why do Privately Insured Mothers Receive More Cesareans than Mothers Who are not Privately Insured?

Abstract

The difference in the risk-adjusted cesarean rates of mothers who are and who are not privately insured is divided into components attributable to the following four factors: the practice style of the physician attending the birth, the closeness of the physician-mother relationship, individual nonclinical factors, and the direct influence of private insurance on the physician's treatment decision. Estimates from two expansive, complementary data sets indicate that the most of the differential is attributable to the first two factors, particularly the pairing of privately insured mothers with physicians who are inclined to perform cesareans. There is some evidence that these pairings are not incidental but the result of firm (and possibly consumer) choices.

Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project

“…Analyzing a nationwide sample of births in 1988 and all Florida hospital births in 1992, Grant (2005) finds that clinical risk factors and matching between privately insured mothers and physicians who are predisposed to perform cesareans explains all but one percentage point of this gap. This remaining difference corresponds to the contribution of financial incentives estimated here.…”

Modelos de assistência ao parto e taxa de cesárea em diferentes países

“…The model of obstetric care has a major role in the physician-patient relationship, economic incentives, utilization of medical technology and cesarean rates. 21,22 Aspects related to malpractice lawsuits 10 and physicians' perception of the mother's desired delivery mode 17 also infl uence medical practice. Few studies have examined economic and incentive-related factors that may be associated to physicians' interests and their decision for a cesarean section and these factors should be analyzed according to the prevailing medical model and forms of payment for services in a given country, region or clientele.…”

“…Few studies have examined economic and incentive-related factors that may be associated to physicians' interests and their decision for a cesarean section and these factors should be analyzed according to the prevailing medical model and forms of payment for services in a given country, region or clientele. 8,22 Wagner 43 (2001) classifi ed the models of childbirth care into three categories:…”

“…Physicians caring for patients with private insurance are better paid and perform more cesareans than those assisting women in the U.S. public health system. 22 Patients with private insurance can choose their doctor while those who seek care in the public sector have a doctor assigned to them. The former allows scheduling a cesarean section but not the latter.…”

“…6,18,22,34 The complexity of factors involved in child delivery and childbirth care has raised questions ranging from the quality of obstetric care to the meaning of childbirth to women. 5 According to the World Health Organization (WHO), childbirth care aims to keep the mother's and her child's health, with minimal medical intervention, and ensure their safety.…”