Cesarean section rates vary from 25% to 50% by U.S. geographic locations among Blue Cross Blue Shield (BCBS) members, with some areas having rates that are more than twice than others, according to an analysis conducted by the provider released Thursday.
BCBS analyzed more than 3 million medical claim deliveries from July 2010 through June 2015. Findings show a downward trend in C-sections nationwide in that time period as the rate decreased to 33.7% from 35.2%. The study marks the first time the Blue Cross Blue Shield Association looked at geographic variations.
The geographic disparities are highly impacted by the differences in physician training and how pregnant patients are treated. "Depending on how people are trained often reflects how they manage their patient populations and so you see some variation associated with training patterns," BCBS Chief Medical Officer Dr. Trent Haywood tells Healthcare Dive.
In the local markets that had at least 5,000 deliveries during the five-year period, Miami, FL had the highest C-section rates in the country (49.6%), while Albuquerque, NM had the lowest (22.7%).
Raised concerns, costs
There are several health complications that result from some C-sections - just like any other surgical operation - such as blood loss. BCBS isn't the only one in the healthcare industry to make an effort to lower the number of women who choose C-sections rather than having vaginal births.
"For over a decade there's been a strong push to really emphasize the benefits both from the infant's perspective as well as from a paternal health outcomes perspective to reduce the rate of elected C-sections and that has to do with the complications associated with C-sections," Haywood says.
From intrauterine growth retardation to when a pregnancy has lasted more than 38 weeks, there are certain situations in which it would be medically necessary to perform a C-section.
However, C-sections are more costly than vaginal births. Haywood says the surgery can cost twice as much. On average, C-section and vaginal deliveries for commercial BCBS cost $17,482 and $13,325.7, respectively, according to the report.
A 2014 Consumer Reports investigation concluded too many C-sections are performed for scheduling ease and because it's more convenient. BCBS suggests further research is needed to assess other contributing factors in variation on more local levels. "We do want to continue to look at cultural and local variation practices," Haywood says.
BCBS launched a the Blue Distinction Centers for Maternity Care program this year with the goal of helping prospective parents look for hospitals that provide quality and affordable maternity care. "One of the things that we want to be able to do within that program is start to address some of these areas by working with pretty closely with providers across the United States to really hone in on this," Haywood says.