The cost of a low-risk childbirth varies widely across the country, but research is lacking to fully understand why, according to new report in Health Affairs.
Overall, the average hospital facility cost for a maternity stay with a low-risk delivery ranged from $1,189 to $11,986 across 463 hospitals, with a mean of $4,485. There was more than a twofold difference between the 10th and 90th percentiles, Xiao Xu, Ph. D., from Yale University, New Haven, Conn., and her colleagues reported.
“Contrary to the common belief that spending more leads to improved outcomes or at least maintains quality of care, we found a significant positive association between estimated hospital facility cost and serious maternal morbidity rate for low-risk childbirths,” the researchs wrote.
The variation remained regardless of the method of delivery, though the range was wider for cesarean delivery. The average cost of vaginal childbirths ranged from $1,183 to $11,819, and costs associated with a cesarean delivery ranged from $1,249 to $13,688 (Health Aff. 2015; 34: 1212-19 [doi:10.1377/hltaff.2014.1088]).
The findings are based on an analysis of discharge data from the 2011 Nationwide Inpatient Sample, which includes data on nonfederal short-term hospitals in 46 states. The researchers focused on low-risk childbirths and excluded deliveries with identified maternal comorbidities, such as preeclampsia, hypertensive disorders, diabetes, and obesity. They also excluded birth with obstetric risk factors, such as multiple gestation or previous cesarean delivery. The final sample included 463 hospitals and 267,120 births. After weighting the sample, the researchers estimated that the sample represented 1.3 million births nationwide.
Researchers found that hospital characteristics accounted for only 13% of the variation in average costs. For example, research showed that costs were significantly higher at rural hospitals (all were nonteaching facilities) than at urban nonteaching hospitals, but costs between urban teaching and urban nonteaching hospitals were comparable. Additionally, compared with investor-owned private hospitals, nonfederal government hospitals and nonprofit private hospitals had significantly higher facility costs.
After other hospital factors were adjusted for, the researchers found that a 1% increase in the serious maternal morbidity rate was associated with a $296 increase in the average facility cost for a maternity stay across low-risk births.
The rate of cesarean deliveries in the study hospitals ranged from 2% to 39% for low-risk births. In one model, researchers estimated that average facility costs for maternity stays were about $432 higher in hospitals with high cesarean delivery rates than in those with low rates. But after the researchers adjusted for mean length of stay, the association was no longer significant.
The researchers recommended establishing standard definitions and management guidelines for common indications for cesarean delivery, such as labor dystocia and abnormal fetal heart rate tracing to help bring down cesarean rates. “The safe reduction of cesarean deliveries may help reduce facility costs and cost variation for childbirth-related hospitalizations,” Dr. Xu and her colleagues wrote.
The wide variation in maternity stay facility costs presents an opportunity for overall cost containment, the researchers wrote, noting that if hospitals above the 75th percentile could reduce costs to the 75th percentile, it would have generated savings of $290 million in 2011 for costs associated with low-risk childbirths.
The study was supported by an award from the Blue Cross Blue Shield of Michigan Foundation. Dr. Harlan Krumholz, one of the study authors, is chair of the Cardiac Scientific Advisory Board for UnitedHealthcare and has contracts with Medtronic Inc. and Johnson and Johnson.