Cesarean Delivery and Healthcare Utilization and Costs in the Offspring: A Retrospective Cohort Study.

OBJECTIVE: To examine the association between cesarean delivery and healthcare utilization and costs in offspring from birth until age 7 years. STUDY DESIGN: A retrospective cohort study of singleton term births in the Canadian province of Nova Scotia between 2003 and 2007 followed until age 7 years was conducted using data from the Nova Scotia Atlee Perinatal Database and administrative health data. The main exposure was mode of delivery (cesarean delivery vs vaginal birth); the outcome was healthcare utilization and costs during the first 7 years of life. Associations were modeled using multiple regression adjusting for maternal prepregnancy weight and sociodemographic factors. RESULTS: In total, 32 464 births were included in the analysis. Compared with children born by vaginal birth, children born by cesarean delivery had more physician visits (incidence rate ratio 1.06, 95% CI 1.05-1.08) and longer hospital stays (incidence rate ratio 1.12, 95% CI 1.03-1.21) and were more likely to be high utilizers of physician visits (OR 1.23, 95% CI 1.10-1.37). Physician and hospital costs were $775 higher for children born by cesarean delivery compared with vaginal birth. CONCLUSIONS: Cesarean delivery compared with vaginal birth is associated with small but statistically significant increases in healthcare utilization and costs during the first 7 years of life.

Public Health Data in Action: An Analysis of Using Louisiana Vital Statistics for Quality Improvement and Payment Reform.

Introduction In 2012, the Louisiana (LA) Department of Health and Hospitals revised the LA birth certificate to include medical reasons for births before 39 completed weeks' gestation. We compared the completeness and validity of these data with hospital discharge records. Methods For births occurring 4/1/2012-9/30/2012 at Woman's Hospital of Baton Rouge, we linked maternal delivery and newborn birth data collected through the National Perinatal Information Center with LA birth certificates. Among early term births (37-38 completed weeks' gestation), we quantified the reasons for early delivery listed on the birth certificate and compared them with ICD-9-CM codes from Woman's discharge data. Results Among 4353 birth certificates indicating delivery at Woman's Hospital, we matched 99.8% to corresponding Woman's administrative data. Among 1293 early term singleton births, the most common reasons for early delivery listed on the birth certificate were spontaneous active labor (57.5%), gestational hypertensive disorders (15.3%), gestational diabetes (8.7%), and premature rupture of membranes (8.1%). Only 2.7% of births indicated "other reason" as the only reason for early delivery. Most reasons for early delivery had >80% correspondence with ICD-9-CM codes. Lower correspondence (35 and 72%, respectively) was observed for premature rupture of membranes and abnormal heart rate or fetal distress. Discussion There was near-perfect ability to match LA birth certificates with Woman's Hospital records, and the agreement between reasons for early delivery on the birth certificate and ICD-9-CM codes was high. A benchmark of 2.7% can be used as an attainable frequency of "other reason" for early delivery reported by hospitals. Louisiana implemented an effective mechanism to identify and explain early deliveries using vital records.

[Elective cesarean section on maternal request--what's new?].

Elective cesarean section on maternal request is a debatable issue with regard to all of its aspects. Current literature discusses topics such as its prevalence, risks and benefits in comparison with vaginal delivery, as well as ethical, judicial and economical questions regarding its execution. We reviewed the relevant literature from the last decade. There are no clear research findings which indicate that overall, elective cesarean section on maternal request is better, or alternatively, more perilous, in comparison with vaginal delivery, from both maternal and fetal or neonatal aspects. Due to its prevalence, there is a need for the obstetric establishment in Israel to make a formal statement regarding its attitude towards this issue.

Making a splash!

The installation of a birthing pool can be a costly and time consuming process. This article provides some practical tips for making the installation run as smoothly as possible, saving work--and money--in the process. This article gives some advice as to what needs to be considered before you go ahead with installing a pool.

Economic implications of home births and birth centers: a structured review.

BACKGROUND: It is widely perceived that home births and birth centers may help decrease the costs of maternity care for women with uncomplicated pregnancies and deliveries. This structured review examines the literature relating to the economic implications of home births and birth center care compared with hospital maternity care. METHODS: The bibliographic databases MEDLINE (from 1950), CINAHL (from 1982), EMBASE (from 1980), and an "in-house" database, Econ2, were searched for relevant English language publications using MeSH and free text terms. Data were extracted with respect to the study design, inclusion criteria, clinical and cost results, and details of what was included in the cost calculations. RESULTS: Eleven studies were included from the United Kingdom, United States, Australia, and Canada. Two studies focused on home births versus other forms and locations of care, whereas nine focused on birth centers versus other forms and locations of care. Resource use was generally lower for women cared for at home and in birth centers due to lower rates of intervention, shorter lengths of stay, or both. However, this fact did not always translate into lower costs because, in the U.K. where many studies were conducted, more midwives of a higher grade were employed to manage the birth centers than are usually employed in maternity units, and because of costs of converting existing facilities into delivery rooms. The quality of much of the literature was poor, although no studies were excluded for this reason. Selection bias was likely to be a problem in those studies not based on randomized controlled trials because, even where birth center eligibility was applied throughout, women who choose to deliver at home or in a birth center are likely to be different in terms of expectations and approach from women choosing to deliver in hospital. CONCLUSIONS: This review highlights the paucity of economic literature relating to home births and birth centers. Differences in results between studies may be attributed to differences in health care systems, differences in methods used, and differences in costs included. Further economic research that involves detailed bottom-up costing of alternative options for place of birth and measures multiple outcomes, including women's preferences, would help address the question of whether out-of-hospital birth is beneficial in economic terms.

Normal delivery and cesarean section: cost per brazilian regions, 2015.

OBJECTIVE: To describe the number of funds made by the Brazilian National Health System to normal delivery and cesarean procedures, according to the Brazilian regions in 2015, and estimate the cost cutting if the recommendation concerning the prevalence of cesarean deliveries by the World Health Organization (10 to 15%) were respected. METHODS: Secondary analysis of data from the Hospital Information System of the Brazilian National Health System. The variables considered were the type of delivery (cesarean section and normal), geographic region of admission, length of stay and amount paid for admission in 2015. RESULTS: In the year 2015, there were 984,307 admissions to perform labor in the five Brazilian regions, of which 36.2% were cesarean section. The Northeast and Southeast regions were the two regions that had the highest number of normal deliveries and cesarean sections. The overall average hospital stay for delivery was 3.2 days. About R$ 650 million (US$ 208,5 million) were paid, 45% of the total in cesarean deliveries. If the maximum prevalence proposed by the World Health Organization (WHO) were considered, there would be a potential reduction in spending in the order of R$ 57.7 million (US$ 18,5 million). CONCLUSIONS: Cesarean sections are above the parameter recommended by the WHO in all Brazilian regions. The Northeast and Southeast had the highest total number of normal and cesarean deliveries and thus the greatest potential reduction in estimated costs (69.6% of all considered reduction).

Strategies for Providing Low-Cost Water Immersion Therapy With Limited Resources.

At our university-affiliated medical center, a major renovation of the women's health and birthing unit resulted in the temporary loss of the permanent tub used for water immersion therapy during labor. Because 40 percent of the women in the nurse-midwifery practice utilize hydrotherapy, we undertook a rigorous search for an interim solution. We developed a safe and cost-effective strategy that can be easily replicated and utilized by others to provide hydrotherapy for laboring women.

Normal delivery and cesarean section: cost per brazilian regions, 2015

SUMMARY OBJECTIVE: To describe the number of funds made by the Brazilian National Health System to normal delivery and cesarean procedures, according to the Brazilian regions in 2015, and estimate the cost cutting if the recommendation concerning the prevalence of cesarean deliveries by the World Health Organization (10 to 15%) were respected. METHODS: Secondary analysis of data from the Hospital Information System of the Brazilian National Health System. The variables considered were the type of delivery (cesarean section and normal), geographic region of admission, length of stay and amount paid for admission in 2015. RESULTS: In the year 2015, there were 984,307 admissions to perform labor in the five Brazilian regions, of which 36.2% were cesarean section. The Northeast and Southeast regions were the two regions that had the highest number of normal deliveries and cesarean sections. The overall average hospital stay for delivery was 3.2 days. About R$ 650 million (US$ 208,5 million) were paid, 45% of the total in cesarean deliveries. If the maximum prevalence proposed by the World Health Organization (WHO) were considered, there would be a potential reduction in spending in the order of R$ 57.7 million (US$ 18,5 million). CONCLUSIONS: Cesarean sections are above the parameter recommended by the WHO in all Brazilian regions. The Northeast and Southeast had the highest total number of normal and cesarean deliveries and thus the greatest potential reduction in estimated costs (69.6% of all considered reduction).

RESUMO OBJETIVO: Descrever o montante de recursos pagos pelo Sistema Único de Saúde por procedimentos de parto normal e cesárea, segundo as regiões brasileiras, em 2015, estimando a redução de gastos caso a recomendação da Organização Mundial da Saúde quanto à prevalência de partos cesáreas (10% a 15%) fosse seguida. MÉTODOS: Emprego de dados secundários presentes no Sistema de Informações Hospitalares do Sistema Único de Saúde. As variáveis consideradas foram: tipo de parto (cesárea e normal), região geográfica de ocorrência, tempo de permanência hospitalar e valor da Autorização de Internação Hospitalar paga, em 2015. RESULTADOS: No ano de 2015 ocorreram 984.307 internações para realização de parto nas cinco regiões brasileiras, sendo 36,2% de partos por cesárea. Nordeste e Sudeste foram as duas regiões que se destacaram, com os maiores números de partos normais e cesáreas. A média geral em dias de internação para parto nas cinco regiões foi de 3,2 dias. Foram pagos aproximadamente R$ 650 milhões (US$ 208,5 milhões), 45% desse total em partos cesáreas. Caso o parâmetro máximo proposto pela Organização Mundial da Saúde fosse considerado, haveria uma redução potencial de gastos na ordem de R$ 57,7 milhões (US$ 18,5 milhões). CONCLUSÕES: Os partos cesáreas estão acima do parâmetro recomendado em todas as regiões brasileiras. As regiões Nordeste e Sudeste se destacaram por representar potencialmente a maior redução na estimativa de gastos (69,6% de toda a redução considerada).

Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off.

OBJECTIVE: To describe the patterns of deliveries in a birth cohort and to compare vaginal and cesarean section deliveries. METHODS: All children born to mothers from the urban area of Pelotas, Brazil, in 2004, were recruited for a birth cohort study. Mothers were contacted and interviewed during their hospital stay when extensive information on the gestation, the birth and the newborn, along with maternal health history and family characteristics was collected. Maternal characteristics and childbirth care financing - either private or public healthcare (SUS) patients - were the main factors investigated along with a description of C-sections distribution according to day of the week and delivery time. Standard descriptive techniques, Χ² tests for comparing proportions and Poisson regression to explore the independent effect of C-section predictors were the methods used. RESULTS: The overall C-section rate was 45%, 36% among SUS and 81% among private patients, where 35% of C-sections were reported elective. C-sections were more frequent on Tuesdays and Wednesdays, reducing by about a third on Sundays, while normal deliveries had a uniform distribution along the week. Delivery time for C-sections was markedly different among public and private patients. Maternal schooling was positively associated with C-section among SUS patients, but not among private patients. CONCLUSIONS: C-sections were almost universal among the wealthier mothers, and strongly related to maternal education among SUS patients. The patterns we describe are compatible with the idea that C-sections are largely done to suit the doctor's schedule. Drastic action is called for to change the current situation.

[High-risk pregnancy, costs and DRG reimbursement]. / Risikofødende, kostnader og DRG-refusjon.

BACKGROUND: The aim of this study was to measure actual costs of delivery of women with high-risk pregnancies in Norway. We calculated the cost difference between Caesarean section delivery and vaginal delivery and compared costs and the reimbursement received by hospitals. The present Norwegian financial system for hospitals has two components: a government reimbursement based on diagnosis-related groups (DRG) covering, in principle, half of hospital costs, and a basic budget received as a block grant. MATERIAL AND METHOD: The study included 75 high-risk pregnant women. We used a prospective, individual bottom-up method based on: 1) hospital stay and the resources required, 2) operating theatre costs, 3) other major procedures, and 4) material and medication costs. Overhead costs (basic and general costs) were added on the basis on five key variables: 1) number of admittances (length of stay), 2) number of discharges, 3) number of employees, 4) floor space, and 5) number of PCs. The total cost for each patient was compared with the reimbursement received. RESULTS: We found that the reimbursement did not cover actual costs. Calculations were made for Caesarean and vaginal deliveries respectively: Mean cost of a Caesarean delivery was NOK 96,556, compared to a DRG reimbursement of NOK 47,137; mean cost of a vaginal delivery was NOK 62,136, with a DRG reimbursement of NOK 27,146.

Custos dos partos vaginais e cesáreas na maternidade de um hospital universitário do interior de São Paulo: um estudo preliminar / Costs os vaginal deliveries and cesarean sections at a university maternity hospital in São Paulo countryside: a preliminary study

As instituições de saúde têm se preocupado com os custos, visando controlar gastos, otimizar recursos e realizar investimentos. O presente trabalho teve como objetivo calcular os custos diretos e indiretos dos partos vaginal e cesárea da maternidade de um hospital universitário, do interior do estado de São Paulo. Trata-se de um estudo do tipo observacional, quantitativo e com análise descritiva dos dados. Foi realizado na Seção Técnica de Enfermagem (STE) em Obstetrícia e Centro Obstétrico do Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista (HCFMB-Unesp). A análise dos dados revelou que a taxa de cesárea foi de 43 por cento; o custo do parto vaginal foi de R$ 693,84 e do parto cesárea, de R$ 755,01. Concluiu-se que a análise dos custos é uma importante ferramenta de gestão e demonstrou-se a necessidade da realização de outros trabalhos na área do gerenciamento de custos.

Estudo sobre custos dos modelos de assistência ao parto normal de baixo risco no Brasil: uma análise exploratória / Study on costs of care delivery models for normal low risk in Brazil: an exploratory analysis

Introdução: Destaca que existe uma considerável variabilidade nos modelos de assistência ao parto normal e que esses modelos devem ser sistematicamente analisados e comparados, para determinação, se houver, do mérito relativo de um modelo de assistência em relação aos outros. Objetivo: Investigar os custos associados ao parto normal de baixo risco, em dois hospitais públicos de uma microregião da cidade de São Paulo, e estabelecer critérios para a criação de um sistema de custeio a fim de que os modelos de assistência ao parto normal de baixo risco venham a ser, futuramente, comparados. Métodos: O levantamento de dados em campo foi realizado em dois hospitais de uma microregião de saúde da zona leste, no município de São Paulo. Entrevistas pessoais foram conduzidas com os funcionários das áreas de Contabilidade ou de Faturamento dos hospitais participantes da pesquisa para obtenção de informações sobre a variável custo e seu tratamento dentro da instituição. Foram realizadas diversas visitas às Maternidades para observação dos insumos consumidos durante a prestação do serviço e as quantidades utilizadas em cada parto. Também foram feitas pesquisas de preço dos insumos relacionados à assistência ao parto. O processamento e análise dos dados foram realizados a partir da criação de planilhas utilizando-se MS-Excel. O ponto de vista adotado foi o do provedor do serviço de saúde. Resultados: Levando-se em conta apenas os custos de material de consumo, saneantes, fármacos, exames e mão de obra, o custo de uma parte normal contabilizou 717,44 reais. O custo da mão de obra correspondeu a 76,49 por cento do total apurado. Conclusões: Verificou-se que, para fazer um cálculo apurado do custo do parto normal, não podem ser ignorados os custos gerais e de capital, pois esses valores são elevados e devem representar uma parcela significativa dos custos totais de um parto normal. Para a determinação do mérito relativo de um modelo de assistência em relação aos outros, deverão ser realizadas Avaliações Econômicas completas que incluam a variação da freqüência dos procedimentos de rotina.