C-section rate impact on health insurance
photo credit: Dave Q
The cesarean section rate in the United States has been steadily on the rise for decades now, and has reached what some would call “epidemic” numbers. Nearly one third of all babies are born by c-section. What financial implications does this have, and how does the insurance industry respond to the 32 percent c-section rate?
Many European countries do not see a prior cesarean as an obstacle to a future vaginal delivery, depending on the reason the c-section was performed in the first place. But in the US, vaginal births after c-section (VBACs) are highly controversial. Many women who have had a surgical birth in the past know they will have another from the time they start using an ovulation calendar and planning the next baby. It doesn’t take a genius to understand that c-sections are more expensive than vaginal deliveries, and that patients’ health insurance companies are likely getting fed up with the rising number of c-sections.
For the insurance company, the cost of surgical births add up: it’s not just the operation itself but the cost of the OR, the surgical team and anesthesiologist, medications used, and longer hospital stay for both mother and baby, often including a period in a Neonatal Intensive Care Unit. Some insurance companies, like the Golden Rule Insurance Company, are saying they have had enough and are unwilling to pick up the bill for a repeat cesarean section. These companies see prior c-sections as a “preexisting condition”, just like asthma, diabetes, or cancer.
In real terms, this means that some women pay higher premiums, while others are rejected for insurance coverage altogether. Some companies will cover women with a prior c-section, but will exclude coverage for another for a certain period of time.
Does this mean that VBACs are preferred by insurance companies, and that they are cheaper? Not at all, unfortunately. A so-called trial of labor after cesarean (TOLAC) comes with added complications too. While a woman who had previously had a c-section is in labor and hoping to give birth vaginally, a surgical team must be at the hospital the entire time, an OR must be kept available, and an anesthesiologist has to be there as well – a policy decided upon by the American College of Obstetricians and Gynecologists. The cost of a VBAC further rises if the woman needs a c-section after all, especially after a life-threatening uterine rupture, which is one of the major risks of VBAC.
The doctor and the hospital also face higher malpractice insurance premiums if they carry out vaginal births after cesarean sections, which led many of them to “ban” VBACs altogether – even for women who are ideal candidates for VBAC, and even if they believe a vaginal birth to be the safer choice.
Who are the victims in this story? There are, in fact, no winners and victims all around. The women who become uninsurable or have to pay higher premiums, or those who have to look all over their state in an effort to find a VBAC provider – while suffering from pregnancy signs and symptoms, are on the losing end. So are doctors and hospitals, who are essentially forced to take insurance costs as well as the best medical interest of the patient into account when making decisions. And then there are health insurers, who are paying for all these initial c-sections. Perhaps it is time for something to change, in everybody’s interest.