How many cesarean sections does your corporate insurance plan pay for in a year? If you work in an industry unrelated to maternity care, you may not think to ask this question – but you should. Why? Because the current cesarean rate in the U.S. today is over 30%, even though the World Health Organization estimates that 15% is the optimal rate for balancing the risks of this major surgery against the benefits. If your business were to achieve half the national rate (i.e. the optimal rate of 15%) it could save your company thousands, if not millions of dollars a year.
“The Cost of Having a Baby in the United States,” a recent report released in January 2013 by Childbirth Connection, states that maternity costs in the US have risen by 50% since 2004 and the “average total Commercial insurer payments for all maternal and newborn care with vaginal and cesarean childbirths were $18,329 and $27,866, respectively.” By avoiding one employee’s cesarean section a year a small company could save more than $9,500. Ten cesareans avoided saves $95,000, and 100 unnecessary cesareans averted by a corporation that currently pays for 350 births annually saves almost one million dollars in a year.
You may be thinking that cesarean surgery is necessary to save the lives of either the mothers or the babies who experience this type of birth. It is true that cesarean, also called C-section, is a life-saving technique. However, they are considered by many experts to be overused. Our nation’s rising maternal death rates, which already put us at the bottom of the barrel compared with other industrialized nations, show that our high rate of C-section is not providing the lifesaving outcomes we desire from such a costly intervention.
Furthermore, a recent study released by the American Academy of Birth Centers shows that ”women who receive care at midwife-led birth centers incur lower medical costs and are less likely to have cesarean birth compared to women who give birth at hospitals.” In fact, the cesarean rates for women transferred to hospitals from birth centers was 6%. This shows that is possible for our maternity care system to do better.
Reforming our maternity care system is a David vs. Goliath fight. Reform-minded underdogs such as midwives and consumer advocates who are armed with scientific and qualitative evidence and cost-saving practices are coming up against well-funded entrenched stakeholders like hospitals, medical societies, and insurance companies that are fighting to keep the status-quo to protect their bottom line. Savvy businesses will recognize that because they are commercial insurers of their employees they already have a horse in this race. It is time for corporations to learn about maternity care, the same way they have about other wellness issues and chronic illness control for their employees, to help bring about changes that will improve outcomes and save lives, and also save our nation billions of healthcare dollars in the process.
The first step for businesses to take to ensure they can realize cost savings in maternity care is to flex their economic muscles and let insurers, hospitals, and medical societies know that lowering the cesarean rate is a priority for your business. Purchases of insurance products, benefits, and wellness packages should reflect that priority. If the adequate products don’t yet exist, corporations can demand that they be created. Healthcare improvement collaboratives can help smaller businesses leverage their power to demand these types of products. Corporate gifts and grants to hospitals can come with the caveat that the hospital show annual progress in reducing their cesarean rates toward the 15% mark and poor results=no more money. Push back against organizations that lobby for non-evidence-based care practices, the exclusion of birth centers, and the limiting of the practice of midwives as care providers. Ensuring access at the state and national levels to birth centers and midwives for care will be an important pathway to economic savings in the coming years.
What can your company do to help employees reduce their chance of having a cesarean birth?
(Truven Health Analytics, Childbirth Connection, Catalyst for Payment Reform, Center for Healthcare Quality and Payment Reform, 2013)
(Susan Rutledge Stapleton CNM, 2013)
The Birth Lady 