INCENTIVES FOR HOSPITALS TO PERFORM C-SECTIONS VS ALLOWING NATURAL BIRTHS
There have been many talks lately about hospitals being offered incentives for performing C-sections over natural births. Some people believe this will lead to more C-sections being performed, while others think that it will simply give hospitals the option to do what’s best for the mother and the baby.
Although the optimal and safe rate for caesareans should be around 15-18%, there has been an increase in the United States from little over 20% in 1996 to nearly 33% in 2011, now we see 87.5% of cesarean cases found in the private sector hospitals!
So, what’s your opinion? Are there any special incentives for hospitals to perform C-sections, or it’s just the need of the hour? Read on to get some insight on this topic.
OVERVIEW OF INCENTIVES FOR HOSPITALS FOR PERFORMING C-SECTIONS VS ALLOWING NATURAL BIRTHS
There are key incentives for hospitals to perform C-sections over natural births.
- Financial compensation:
- The first is monetary compensation. Hospitals are typically reimbursed more for performing C-sections than for natural births. The average reimbursement for a C-section is almost triple that for a vaginal birth.
- Bonus payment from insurance companies:
- In addition, many hospitals receive bonuses for meeting specific C-section rates. For example, if a hospital’s C-section rate is below a certain percentage, the hospital may lose out on bonus payments from the insurance company. According to the Agency for Healthcare Research and Quality, maternal and neonatal hospitalizations not only account for more than 20% of all hospital admissions in the United States, but they are also the most significant contributor to hospital expenses, accounting for more than a quarter of the total amount transferred by health insurance companies.
- Boost a hospital rating:
- Finally, many hospitals are rated on their quality of care by agencies like Medicare and Medicaid. A high C-section rate can help a hospital’s rating, while a high rate of natural births can hurt it.
- Reduces the staff cost in the private sector:
- Another issue is that because of the lengthier help or process required in vaginal deliveries, the intervention becomes a convenient one to complete the birth process quickly without incurring financial losses, and this is especially the case in private sector hospitals where staff is paid based on per event instead of the public sector where staff is paid based on shift.
Apart from this, some factors that have been identified for the increased C-section cases include:
- Judicialization of health (not only because of the demand for access to new technologies but also because of concerns about unexpected outcomes such as childbirth anoxia)
- Patient pain-related fear with 46.6% of women found in a study with this issue
- Lack of training for health professionals in vaginal delivery.
HOW MUCH DOES A HOSPITAL MAKE PER C-SECTION VS PER NATURAL BIRTH
As we all know, healthcare expenses have risen dramatically in recent years, putting public health at risk. Obstetric care substantially contributes to this scenario because it accounts for 20% of all healthcare spending.
As discussed already, cesarean sections (C-sections) are becoming more common worldwide and also more expensive. Cesarean delivery is not only more costly, but it is also associated with lower mother and newborn outcomes.
C-section births usually cost more for the hospital than natural births, providing more of a financial incentive for hospitals. In some cases, hospitals can make up to three times as much money from a C-section as they do from natural birth.
For Medicaid, the average cost of cesarean delivery, including prenatal care, birthing, and postoperative care, is US$13,590.00 per occurrence. However, with vaginal deliveries, the cost is approximately 30% lower, i.e., US$9,131.00.
The increased use of medications, the special team, needed to assist in a C-section, and the expected readmission after the delivery make it an overall costly process compared to the natural birth.
As hospitals make more money from performing C-sections than from natural births, as a hospital is a business, and their customers are named patients, there seem to be contradictory motives in the planning of health, as shown by the recommendation of a C-section over a natural birth.
While there are some benefits to performing C-sections, it’s important to remember that they are serious and potentially life-threatening surgeries and should only be performed when the mother or child’s life is at risk and deemed absolutely necessary.
COMPLICATIONS THAT ARISE WITH C-SECTION
While some hospitals may be incentivized to perform C-sections instead of natural births, it’s essential to be aware of the risks that come along with the surgery.
- Can lead to severe complications:
- C-section births can be riskier for both mother and child when compared to natural childbirth. In some cases, the procedure can lead to serious complications like hemorrhaging, infection, and problems with the newborn.
- Poor breastfeeding outcome and increased chance of ICU admission:
- In a study, 9345 deliveries were examined, and it was found that the C-section group had significantly lower rates of breastfeeding in the first hour after delivery, a higher rate of intensive unit care (ICU) admission for both the mother and the newborn, and a higher average hospitalization cost. C-sections mostly require a more extended hospital stay, increased hospital readmission up to 30 days from delivery, and more human resources for support.
- Increases health risk for the mother:
- Furthermore, unnecessary C-sections appear to increase the risk of the parturient, as their inadvertent may increase the chances of maternal death by 3.7 times and amniotic embolism by approximately five times, as well as being linked to a higher future incidence of abnormal placental insertion.
- Increases health risk for the baby:
- According to the literature, newborns of elective caesareans are more likely to experience respiratory distress than those whose moms went through labor.
In short, Cesarean deliveries in low-risk pregnancies are linked with a lower delivery value because they are more expensive and have poor perinatal outcomes.
PROS AND CONS OF C-SECTIONS VS PROS AND CONS OF NATURAL BIRTHS
There are pros and cons to both C-sections and natural births.
Pros and cons of C-sections:
- Many people believe that C-sections are safer for the baby, as they can be planned and there is less risk of complications during labor.
- As you are under the anesthesia effect, the process of birth is not painful as labor pain.
- But as already mentioned, C-sections can cause respiratory problems in newborns later.
- Secondly, C-section is a major surgery with risks and recovery issues such as surgical wound infection.
Pros and cons of vaginal delivery:
- Natural births can also be dangerous for the baby, as there is a risk of complications during the labor, but they are also less invasive and carry fewer risks for the mother.
- A study based on 23,940 postpartum women from a national hospital-based cohort found that 68.5% of women preferred vaginal delivery. The primary reason for this is the best recovery offered by this type of delivery.
- Considering the ICU admission rates, the women’s outcomes in vaginal birth are better.
- The neonatal outcomes are also better with vaginal birth, especially when ICU hospitalization and breastfeeding in the first hour following delivery are considered.
- Research suggests that vaginal deliveries are connected with higher healthcare-value delivery.
- However, in both public and private sectors, the cesarean section percentage has been higher than vaginal delivery. Ultimately, the decision of whether to have a C-section or a natural birth should be made between the mother, her loved ones, and the medical doctor, based on individual circumstances as in some conditions C-section is a necessity and forcing a vaginal delivery can result in severe consequences.
HOSPITAL POLICIES ON C-SECTIONS VS NATURAL BIRTHS
There’s no one-size-fits-all answer to the question of whether or not hospitals should incentivize C-sections over natural births. It depends on various factors, including the hospital’s policy, the doctor’s preference, and the patient’s wishes.
In some cases, it may be medically necessary to perform a C-section; in other cases, a natural birth may be preferred. Ultimately, it all comes down to the hospital’s particular policies and if the policies incentivize c-sections. If so, it may be best for the expectant mother to either have a home-birth, or find a hospital that actually has the best interest of the mother to be, by pursuing natural birth options.
WHAT CAN BE DONE:
The ideal model for deciding which procedure to go for is difficult to develop, especially given the variations between public and private institutions. Some rules or regulations and tips that can be followed are:
- Paying fixed amounts to hospitals: Using the Global Budget and paying doctors’ salaries have been used to manage hospitals. In this situation, the hospital is paid a certain sum (monthly or yearly) to provide its services, regardless of the number of resources used.
This approach is employed in several Social Health Organizations, where non-profit organizations operate government hospitals by fixed monthly values and targets are accomplished. In contrast, additional remuneration is granted only through specific procedures or accreditation’s.
- Bonus scheme for professionals as a reward for value delivery: A better structure of a bonus scheme for professionals tied to value delivery, in addition to the salary payout, could also be considered.
- A more robust health system and medical education: Finally, a stronger health system and medical education process are required to improve the vaginal delivery rate and, as a result, obtain better outcomes and lower delivery expenses. Currently the opposite is being followed; less education for doctors and patients on the various natural delivery methods.
THE BOTTOM LINE
Cesarean deliveries cost more, and several reasons are documented for this. Until we address the issue of incentives for hospitals in case of C-sections, the rates will likely continue to rise.
An unbiased decision based on what’s best for the mother and the baby, irrespective of the hospital benefits, must be encouraged to provide more value-based healthcare.
Got a question? Leave it below in the comments!
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