Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues

Abstract

Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteenfold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordinating maternity care, collecting and measuring more data, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting.

EXHIBIT 1

Caption: Distribution Of Hospital Cesarean Rates In The United States, 2009 Source/Notes: SOURCE Authors’ calculations based on data from the 2009 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP). NOTES Distribution of cesarean delivery rates in a representative sample of US hospitals with at least 100 births in 2009 (N = 593). Hospital cesarean rates ranged from 7.1 percent to 69.9 percent--a tenfold variation across hospitals.

EXHIBIT 2

Caption: Distribution Of Hospital Cesarean Rates In US Hospitals Among Lower-Risk Pregnancies, 2009 Source/Notes: SOURCE Authors’ calculations based on data from the 2009 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP). NOTES Distribution of lower-risk cesarean delivery rates in a representative sample of US hospitals with at least 100 births in 2009 (N = 593). “Lower-risk cesarean” is calculated as the percentage of cesareans among women with term, singleton, and vertex pregnancies with no prior cesarean deliveries. Hospital lower-risk cesarean rates ranged from 2.4 percent to 36.4 percent--a fifteenfold variation across hospitals.