Cesarean Deliveries for Medicaid Patients

OBJECTIVE: The aims of the study were to describe the difference in cesarean delivery rates for Medicaid patients according to hospital type and adjusted for case mix and to determine cost implications for additional cesarean deliveries. STUDY DESIGN: This retrospective study used California discharge data for 92,800 patients delivered in 78 hospitals in Los Angeles County during 1991. Multivariable logistic regression was used to adjust for case mix and to calculate adjusted cesarean delivery rates according to hospital type. Cost estimates assumed $821 per day hospital reimbursement. RESULTS: The unadjusted cesarean delivery rate in private nonteaching hospitals (reference group) was 24.5%, compared with 13.2%,17.4%, and 16.5% in public, health maintenance organization, and private teaching hospitals, respectively. Adjustment for case mix decreased the cesarean delivery rate in public (9.0%), health maintenance organization (12.0%), and private teaching hospitals (8.0%). Cesarean deliveries performed on patients in private nonteaching hospitals result in an additional $13.6 million in Medicaid health care expenses. CONCLUSIONS: There are increased health care costs related to increased cesarean deliveries performed on Medicaid patients in private nonteaching hospitals.