C-SECTIONS: STUDIES EXAMINE MEDICAID RATES, TRIALS OF LABOR
Women receiving Medicaid in New York are "more prone toThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
having complications when giving birth, but are less likely to
undergo Cesarean sections," AP/BOSTON GLOBE reports. A state-
wide report released yesterday by Boston-based HealthShare
Technology Inc. analyzed the 260,183 deliveries in the state in
1994; 40% of the births were to Medicaid recipients (Bauder, 9/4)
The report, "Healthcare for New Mothers," found "startling
differences in health care in the areas of complicated delivery
rates, lengths of hospital stay and charges" (HealthShare
FINDINGS: The study found that one in five Medicaid mothers
had C-sections, compared to 26% of women with other forms of
insurance (AP/GLOBE, 9/4). In addition, Medicaid recipients were
35% more likely to experience complicated deliveries and averaged
3.1 days in the hospital following birth compared to an average
stay of 2.8 days for non-Medicaid mothers. The study found that
Medicaid births were more expensive than non-Medicaid births; the
state-wide average charge was $4,118 for women on Medicaid versus
$3,351 for women with other insurance. According to HealthShare,
the higher costs were due to higher complication rates and
increased utilization of resources associated with complications
(HealthShare release, 9/4).
PAYMENT PLAN: According to the state health department,
"Medicaid's reimbursement for C-sections is lower than that for
most private insurers." HealthShare founder Richard Siegrist Jr.
said that the study data should be used to question "how much
economic factors are taken into account when medical decisions
are made." Kristine Smith, a spokesperson for the state health
department, said that while economic factors are "one factor" in
medical decisionmaking, "We do not believe that it is the only
factor and that there are other factors equally at play here."
She noted that Medicaid recipients "tend to be younger than women
with private insurance" and are more likely to delivery vaginally
and less likely to request a C-section (AP/GLOBE, 9/4).
TRIALS OF LABOR: Women who try a vaginal birth after a C-
section delivery (VBAC) are "almost twice as likely" to
experience "major maternal complications" than those who choose a
subsequent C-section, according to a new study in today's NEW
ENGLAND JOURNAL OF MEDICINE (NEJM) (McMahon, 9/5 issue). The
study found that the risk of complications was 1.6% for whose
women who attempted vaginal deliveries and 0.8% for those who
underwent a C-section (Winslow, WALL STREET JOURNAL, 9/5).
However, USA TODAY notes that the study of 6,138 Canadian women
found that for the most part, attempting a vaginal delivery is
"very safe" and is successful 60% to 80% of the time. According
to the study's lead author, Dr. Michael McMahon of the University
of North Carolina at Chapel Hill, the problem is that the failed
attempts usually require emergency C-sections that follow long
and difficult trials of labor (Painter, 9/5).
REDUCING THE NUMBERS: Public efforts currently underway are
attempting to reduce the number of C-sections performed in the
U.S. from 25% to 15% (JOURNAL, 9/5). And NPR's Que notes that
"increasingly, managed care companies are now requiring all women
to first attempt a vaginal delivery -- even if they've had a
Caesarean in the past." But McMahon cautions that we "need to be
careful that we don't mandate that women undergo a trail of
labor" ("Morning Edition," 9/5). But he also said that doctors
who refuse to advise women to attempt a vaginal delivery
following a C-section are "as guilty as managed care companies
that mandate a trial of labor without giving women a choice"
(JOURNAL, 9/5). In a NEJM editorial in today's issue, University
of Southern California's Dr. Richard Paul said repeat C-sections
account for only one-third of all C-sections; the rest are first
time deliveries. As a result, he said, first-time C-sections are
the ones insurers should be attempting to reduce (9/5 issue).