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

Health Aff (Millwood). 2013 Mar;32(3):527-35. doi: 10.1377/hlthaff.2012.1030.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cesarean Section / economics*
  • Cesarean Section / statistics & numerical data*
  • Cost-Benefit Analysis
  • Delivery of Health Care / economics
  • Delivery of Health Care / statistics & numerical data
  • Female
  • Health Services Misuse / economics*
  • Health Services Misuse / statistics & numerical data*
  • Health Services Research
  • Hospitals / statistics & numerical data
  • Humans
  • Practice Patterns, Physicians' / economics*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pregnancy
  • Quality of Health Care / economics*
  • Quality of Health Care / organization & administration*
  • Risk Factors
  • United States
  • Utilization Review / statistics & numerical data