Wednesday, June 17, 2009

Childbirth: the low-hanging fruit of health care reform

Quick, what’s the number one reason to be hospitalized in this country? Heart attack? Car accident? Here’s a hint: It’s not a disease. It’s not even an injury.

The answer is childbirth. And what’s the most common operating room procedure? C-section.

Given that 85 percent of women give birth and it’s no secret how 240 million Americans arrived in the world, this shouldn’t be a surprise. Nor should it really be a surprise that maternal and newborn charges are far and away the nation’s number one hospital cost, $86 billion in 2006, according to Childbirth Connections. Given all this, you’d think that, as talk of health care reform, and especially containing health care costs, fills the media, childbirth would be a major topic.

You’d be wrong. I haven’t read a peep about it in all the newspaper and magazine articles on Obama’s drive to cut health care costs, except for a couple of good articles in USA Today last December, generated by a report from Childbirth Connections.

There’s been a lot of attention paid to the ways the country pays too much for the wrong kind of care. A recent article in the New Yorker made the point that some parts of the country spend much more on medical care than others, without being healthier for it, the moral of the story being that we can cut costs while improving care. Obama reportedly passed this article around to members of Congress (hallelujah, an intellectually curious president for a change).

Yet oddly the article didn’t mention childbirth, even though C-section rates vary wildly by region and by hospital, and the nation’s C-section rate is over 30 percent, more than double what the World Health Organization recommends, which is to say that half of all U.S. C-sections are unnecessary. USA Today estimates unnecessary C-sections per year cost the nation at least $2.5 billion a year, but that is surely conservative, given that there are probably 700,000 unnecessary C-sections, each costing at least $5,000 more than a vaginal birth (not to mention the costs from additional medical complications). Add in the other childbirth interventions—such as episiotomies or continuous fetal monitoring—that are routinely done far in excess of what evidence recommends, and there have to be tens of billions of dollars that could be cut from our spending on childbirth each year while improving care.

As a doctor put it to USA Today, "Fortunately, maternity care is a place where good care and good economics come together."

Why aren't other media covering this?

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