Healthy birth and rising c-section rates are getting a lot of journalism coverage this week! Heres the NYTimes with one of the best articles Ive read in a while: If cesarean rates for low-risk births vary by 500 percent from hospital to hospital, then clearly hospital policies matter. Examining what San Francisco General does to achieve its low rates might show what other hospitals could do as well. Probably the single most important factor is that doctors at General are salaried and on shifts. Their pay doesn’t vary by the number of patients they see or tests they order. They’re paid for their time: 12-hour shifts during the weekday, 24 hours on weekends. (Since it is a teaching hospital for the University of California-San Francisco, residents can handle routine business when attending physicians need to nap.) Paying doctors for their time removes the two most powerful incentives encouraging private-practice doctors to do C-sections. One is money. California’s Medicaid program, Medi-Cal, wisely pays the same for all births, so doctors have no financial incentive to do a C-section with Medi-Cal patients. That’s not the case with commercial insurers, according to the Maternal Quality Care Collaborative. But this is not the most important way that the financial incentives push doctors in the wrong direction. Perhaps more important is the fact that most of what a private-practice ob-gyn doctor earns from taking care of a pregnant woman comes from the delivery. That means doctors have a strong financial incentive to deliver their patients’ babies themselves. mobile.nytimes/blogs/opinionator/2014/05/07/in-delivery-rooms-reducing-births-of-convenience/?_php=true&_type=blogs&smid=fb-share&_r=0
Posted on: Wed, 14 May 2014 05:38:23 +0000
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