[lbo-talk] The business of being born

[Jenny Brown]

Joanna wrote:
> I saw a documentary called "The Business of Being Born," which looks at 
> the technology/business of being born in the U.S. and questions our 
> current approach, which is actually resulting in a 33% caesarean 
> rate...40% in some parts of New York.
>
> Now, these are insane numbers. Utterly insane. The U.S. is the only 
> developed country with these kinds of numbers. The reasons behind it are 
> mostly ideological (the whole birthing business has a very sad and 
> horrific history in modern medicine).
>
> But what really confuses me is why the Insurance companies are putting 
> up with it. I mean, not only do they have to pay more, but there are 
> proven, workable alternatives.
>
> Any ideas?
Public Citizen's Health Research Group did an extensive study in 1994 of 
unnecessary c-sections and the authors found that there was a much 
higher rate (20% vs. 30%) in for-profit hospitals than in public or 
non-profit hospitals.  And as you say caesareans are more expensive (at 
the time of the study around $8,000 for a c-section vs. $4,500 for a 
normal delivery).  The study also suggested that the method of payment 
correlated with the rate, with the 'better-paying' insurance plans 
closely tracking higher c-section rates.  So in that regard, insurance 
companies are having some effect, but the rates keep rising.  The study 
notes various hospitals which lowered their c-section rates by 
instituting stricter guidelines--most of them were university or public 
hospitals, so they were obviously responding to costs. 

It was unclear that malpractice fears affected individual physicians' 
c-section rates, but certain hospitals seemed to encourage c-sections 
for insurance reasons (perhaps affected by local experience of being 
sued).  But the study also found rising c-sections in countries where 
malpractice was not as much of an issue (India and Brazil).  So then we 
return to the explanation of convenience and control by the medical 
staff--you can schedule a c-section, but not a normal birth.  And it's 
something the doctor does, rather than the woman doing it.  Those are 
powerful factors for the insurance companies to battle.  I think they'd 
just rather work on kicking patients out of the hospital sooner.

Jenny Brown