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Am J Public Health. 1990 March; 80(3): 313–315.
PMCID: PMC1404683

Cesarean section use and source of payment: an analysis of California hospital discharge abstracts.


This study assessed the relation between payment source and cesarean section use by analyzing California data on hospital deliveries. Of 461,066 deliveries in 1986, cesarean sections were performed in 24.4 percent. Women with private insurance had the highest cesarean section rates (29.1 percent). Successively lower rates were observed for women covered by non-Kaiser health maintenance organizations (26.8 percent), Medi-Cal (22.9 percent), Kaiser (19.7 percent), self-pay (19.3 percent), and Indigent Services (15.6 percent). Vaginal birth after cesarean (VBAC) occurred more than twice as frequently in women covered by Kaiser (19.9 percent) and Indigent Services (24.8 percent), compared to those with private insurance (8.1 percent). Sizable, although less pronounced, associations between payment source and cesarean section use were noted for the indications of breech presentation, dystocia, and fetal distress. Accounting for maternal age and race/ethnicity did not alter these findings. Variations in the use of cesarean section have a substantial financial impact on health care payors.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Wennberg J, Gittelsohn A. Variations in medical care among small areas. Sci Am. 1982 Apr;246(4):120–134. [PubMed]
  • Hornbrook MC, Berki SE. Practice mode and payment method. Effects on use, costs, quality, and access. Med Care. 1985 May;23(5):484–511. [PubMed]
  • Rutkow IM. Obstetric and gynecologic operations in the United States, 1979 to 1984. Obstet Gynecol. 1986 Jun;67(6):755–759. [PubMed]
  • Roemer R. The right to health care--gains and gaps. Am J Public Health. 1988 Mar;78(3):241–247. [PMC free article] [PubMed]
  • Kizer KW, Ellis A. C-section rate related to payment source. Am J Public Health. 1988 Jan;78(1):96–97. [PMC free article] [PubMed]
  • Williams RL, Chen PM. Controlling the rise in cesarean section rates by the dissemination of information from vital records. Am J Public Health. 1983 Aug;73(8):863–867. [PMC free article] [PubMed]
  • de Regt RH, Minkoff HL, Feldman J, Schwarz RH. Relation of private or clinic care to the cesarean birth rate. N Engl J Med. 1986 Sep 4;315(10):619–624. [PubMed]
  • Anderson GM, Lomas J. Determinants of the increasing cesarean birth rate. Ontario data 1979 to 1982. N Engl J Med. 1984 Oct 4;311(14):887–892. [PubMed]
  • Taffel SM, Placek PJ, Liss T. Trends in the United States cesarean section rate and reasons for the 1980-85 rise. Am J Public Health. 1987 Aug;77(8):955–959. [PMC free article] [PubMed]
  • Flamm BL, Lim OW, Jones C, Fallon D, Newman LA, Mantis JK. Vaginal birth after cesarean section: results of a multicenter study. Am J Obstet Gynecol. 1988 May;158(5):1079–1084. [PubMed]
  • Placek PJ, Taffel SM. Vaginal birth after cesarean (VBAC) in the 1980s. Am J Public Health. 1988 May;78(5):512–515. [PMC free article] [PubMed]
  • Fraser W, Usher RH, McLean FH, Bossenberry C, Thomson ME, Kramer MS, Smith LP, Power H. Temporal variation in rates of cesarean section for dystocia: does "convenience" play a role? Am J Obstet Gynecol. 1987 Feb;156(2):300–304. [PubMed]
  • Gould JB, Davey B, Stafford RS. Socioeconomic differences in rates of cesarean section. N Engl J Med. 1989 Jul 27;321(4):233–239. [PubMed]
  • Gold RB, Kenney AM, Singh S. Paying for maternity care in the United States. Fam Plann Perspect. 1987 Sep-Oct;19(5):190–206. [PubMed]
  • Wilner S, Schoenbaum SC, Monson RR, Winickoff RN. A comparison of the quality of maternity care between a health-maintenance organization and fee-for-service practices. N Engl J Med. 1981 Mar 26;304(13):784–787. [PubMed]
  • Myers SA, Gleicher N. A successful program to lower cesarean-section rates. N Engl J Med. 1988 Dec 8;319(23):1511–1516. [PubMed]

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