Online Program

Cesarean section rate variation across hospital referral regions in Texas: A claims analysis of privately insured population from 2008-2011

Monday, November 4, 2013

Rohan Parikh, MS, Management, Policy and Community Health, University of Texas, School of Public Health, Houston, TX
Suthira Taychakhoonavudh, MS, Management, Policy and Community Health, University of Texas, School of Public Helath, Houston, TX
Cecilia Ganduglia, MD DrPH, Management Policy and Community Health Department, University of Texas Health Sciences Center Houston, School of Public Health, Houston, TX
Luisa Franzini, PhD, Management, Policy and Community Health Division, University of Texas School of Public Health, Houston, TX
OBJECTIVE: With more than one-third of births delivered by cesarean section (C-section) in the U.S. and a substantial variation across states, the study assessed the rate of C-section's performed across hospital referral regions (HRR's) within Texas. METHODS: The study used 2008 – 2011 inpatient claims data from Blue Cross Blue Shield (BCBS) of Texas, largest commercial insurance provider in Texas. Of the 6,486,226 members enrolled in BCBS, about 51% were females. Delivery procedures were identified using diagnosis related groups (C-section: 765,766; Normal: 767, 768, 774, 775) and only females of child bearing age (15-44 years) at the time of admission were included in the study. Claims were mapped to twenty two Texas HRR's using the billing provider zip codes. RESULTS: A total of 108,335 delivery procedures were performed among BCBS insured females across Texas from 2008-2011. The weighted average rate of C-sections for Texas was found to be 39.30% (median: 40.28%); with the lowest rate observed for Wichita Falls at 27.11% and the highest for El Paso at 53.38%. Based on the index of variation calculations, El Paso was 35.83% higher than the state's average while Wichita Falls was 31.02% below the state's average. C-section rates increased linearly across age groups (15-19 years: 23.57%; 20-24 years: 30.81%; 25-29 years: 35.49%; 30-34 years: 41.22%; 35-39 years: 48.70%; 40-44 years: 55.03%) and were found to be stable over a period of four years. CONCLUSIONS: Overall, Texas is nearly 6% above the national average of births by C-section for commercial plans but considerable variation exists across HRR's. Further exploration is required in understanding factors that lead to such variations and high rates of C-section procedures.

Learning Areas:

Public health administration or related administration
Public health or related research

Learning Objectives:
Evaluate geographic variation in cesarean section rates across hospital referral regions in Texas

Keyword(s): Health Care Utilization

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am PhD student in Health Economics and I have worked and published multiple studies that evaluate health care utilization and costs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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