19 Jan – What would maternity care look like if doctors only intervened when it was medically necessary?  For more than a year now, I’ve been trying to answer that question in terms of the physical health of the mother and child. But for a moment let’s forget about increasing maternal mortality and babies in the neonatal intensive care units – and look at what happens to our national health care bill.

Nathanael Johnson

California Watch

Intermountain Healthcare released a study yesterday showing that if the U.S. cesarean surgery rate (32 percent of all births at last count) fell to the rate in Intermountain hospitals (21 percent), the country would save $3.5 billion in medical charges each year.

There are a couple of caveats, which I’ll take into consideration below, but first, here’s what Intermountain had to say:

Nationally, about one in three births are by C-section – the most common surgery in U.S. hospitals today. This represents an all-time high, increasing by more than 50 percent since the 1990s. In 2008, Intermountain estimates that 473,592 C-sections in the U.S. were potentially unnecessary. These births result in higher (national) average maternal charges – $16,671.89 compared to $9,428.08 for a vaginal birth – and increased medical complications for the mother and baby. (Intermountain’s average charges were $9,101.35 for a C-section and $4,964.30 for a vaginal birth.)

Intermountain, a nonprofit health care provider based in Utah, has long been a model for national policy makers. President Obama has cited its work. A New York Times Magazine profile by reporter David Leonhardt singled it out (especially in obstetrics) as an exemplar. And here at California Watch we have looked to its record as an example of what can be accomplished.

Intermountain’s cesarean rate has been driven down by its insistence on delivering babies when they are ready, rather than early.

But that’s not the only cause of Intermountain’s low cesarean rate, and here come the caveats. Utah has lower rates in general – and the reasons for this are not clear.

The other point of clarification is one that always bedevils calculations on health economics: Intermountain is making its figures based on the amounts it charges, rather than the amounts that patients and insurance companies actually pay.

If you’ve ever examined your bill after a hospital visit, you know that you’ll get charged one amount, but your insurance company will often slash that number down significantly. It’s a strange system, and it means that every insurance company pays a different amount for the same procedure.

This makes it nearly impossible to do large-scale calculations like this with any degree of accuracy.  Still, you can look at this study as a benchmark. It tells us roughly that there are a lot of dollars to be saved by simply giving mothers better care.

As policy makers work to reef the sails on our health care system, they should be paying attention to this report, and others (like this one), that show that in this particular sector, less is probably more.