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Reducing cesarean delivery rates in managed care organizations
1Institute of Epidemiology and Health Services Research, Jackson State University, MS 39213, USA. anthony.r.mawson@jsums.edu
The American Journal of Managed Care
|September 6, 2002
Summary
Managed care organizations can reduce high cesarean delivery (CD) rates by implementing evidence-based guidelines and financial incentives for vaginal births. This strategy aims to lower CD rates without alienating providers or consumers.
Area of Science:
- Obstetrics and Gynecology
- Healthcare Management
- Public Health
Background:
- A national consensus identifies current cesarean delivery (CD) rates as excessively high.
- Cesarean delivery rates in managed care organizations (MCOs) are approximately 22%.
Purpose of the Study:
- To review cesarean delivery (CD) practices.
- To discuss strategies for reducing CD rates in MCOs to 10%-15% within five years, aligning with World Health Organization recommendations.
Main Methods:
- Literature review to identify effective strategies for CD rate reduction.
Main Results:
- Provide physicians with evidence-based clinical practice guidelines and acuity-adjusted CD rate data.
- Offer financial incentives for vaginal births after a previous CD.
- Implement hospital-level criteria for labor progress, review CD indications, encourage vaginal birth after CD, and require second opinions for non-emergency CDs.
- Distribute educational materials to pregnant MCO members promoting vaginal delivery.
Conclusions:
- MCOs should report on the implementation, monitoring, and outcomes of CD reduction programs.
- The goal is to lower CD rates effectively while maintaining positive relationships with physicians and avoiding overly rigid approaches that could alienate consumers.