Study Finds Calif. Hospitals Profit From Record Numbers of Cesarean Births

For-profit hospitals across the state are performing cesarean sections at higher rates than nonprofit hospitals, a California Watch analysis has found.

A database compiled from state birthing records revealed that, all factors considered, women are at least 17 percent more likely to have a cesarean section at a for-profit hospital than at one that operates as a non-profit. A surgical birth can bring in twice the revenue of a vaginal delivery.

In addition, some hospitals appear to be performing more C-sections for non-medical reasons – including an individual doctor’s level of patience and the staffing schedules in maternity wards, according to interviews with health professionals.

Across the state, more women are having C-sections for a variety of reasons: a rise in obesity and the number of older mothers, fear of lawsuits among doctors and hospitals, and a growing cultural acceptance of the procedure. Rather than examine these well-known trends, California Watch looked at why individual hospitals are performing cesarean sections at higher rates than others.

The statewide database revealed significant differences among 253 hospitals in California. Women, whose pregnancies were deemed to be low-risk, had a 9 percent chance of giving birth by C-section at the nonprofit Kaiser Permanente Redwood City Medical Center, for example. At the for-profit Los Angeles Community Hospital, women had a 47 percent chance of undergoing a surgical birth. When you factor in moms who needed to have C-sections for medical reasons, the Los Angeles hospital’s rate jumps to 59 percent. In Riverside County, hospitals just miles apart had dramatically different rates, even though they serve essentially the same population.

The numbers provide ammunition to those who have long suspected that unnecessary C-sections are performed to help pad the bottom line.

“This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate," said Desirre Andrews, president of the International Cesarean Awareness Network, a nonprofit group that would like to see C-sections only in cases of medical need.

To doctors and other health professionals, the results of the analysis were troubling.

“We take this extremely seriously. The wide variation in C-section rates really is a cause for concern,” said Dr. Jeanne Conry, California district chairwoman of the American Congress of Obstetricians and Gynecologists.

The analysis challenges some common assumptions about C-sections, including that wealthier women are more likely to opt for a surgical birth. Higher C-section rates were found at hospitals catering to all ethnic groups and economic classes. And there was no correlation between C-section rates and the percentage of a hospital’s business from low-income or indigent patients receiving Medi-Cal, the state’s Medicaid program.

But of the five hospitals in California with the highest C-section rates, four were for-profit hospitals in poorer parts of Los Angeles County, where the African-American and Hispanic populations are above the state average. Hospitals in Southern California tended to have higher rates than in the north, which may suggest a cultural influence.

This was the first independent analysis of C-section rates at the 253 hospitals reporting birth statistics to state health authorities from 2005 through 2007 and the first showing for-profit hospitals with higher rates than nonprofit ones. Studies in other countries have shown the same relationship between for-profit health care institutions and C-sections.

But some hospital officials dispute the notion that their institutions could be pushing C-sections for money. It is “a wrong premise,” according to Tenet Healthcare representative Rick Black, who said the decision to perform the surgery is made by the doctor and patient, while the hospital exerts no direct influence.