The hospitals in this report include Pennsylvania birthing hospitals with 50 or more deliveries in 1995. The hospital names are listed as they were reported in 1995 and may have changed since then. These data do not include Pennsylvania residents who gave birth out of state.
Most hospitals in the Commonwealth of Pennsylvania are prepared for childbirth deliveries, although they may differ in their expertise, approach, policies, and abilities to deal with different kinds of patients, such as high-risk patients. It is important to note that certain hospitals may have a higher C-section rate because they specialize in high-risk pregnancies. In these types of pregnancies, it is more likely that a C-section will be medically necessary. One way to identify such hospitals is to look at the level of neonatal unit care located in the first set of tables.
A level of neonatal care is assigned based upon the types of inpatient services available. The levels apply to the hospital's status as of June 30, 1995 only, and may be different today.
Level 1 hospitals are able to care for low-risk patients admitted to the obstetrical service. They can care for the mother after delivery and for healthy babies until discharge. They should have an established system for identifying high-risk patients who should be transferred to a hospital which provides Level 2 or Level 3 care, and for the transfer of unexpectedly small or sick babies.
Level 2 hospitals take low-risk cases as well, but also have expertise in managing high-risk mothers and newborns.
Level 3 hospitals provide comprehensive care for mothers and newborns of all risk categories.
The tables related to hospital average charges and length of stay are important in highlighting the cost and resource implications of reducing the rate of C-sections. These figures are case-mix adjusted to account for the fact that not all hospitals treat the same kinds of patients. The adjusted figures allow you to more fairly compare hospitals which treat a greater number of complex (and more costly) cases with those that treat less complicated ones.
The charges reported are for services billed to the patient by the hospital, or to whoever is paying for the patient's care. They do not reflect physician fees, which are billed separately. These figures are derived from hospital billing forms, which list the actual charges for each patient. However, hospitals usually do not receive full reimbursement of their charges, having negotiated discounts with insurance companies or other large purchasers of health services. The amount actually collected by the hospital may differ substantially from the amount billed.
An analogy can be made to the purchase of an automobile. Each automobile has a manufacturer's suggested list price (the charge). But the amount the buyer actually pays depends upon his or her ability to negotiate a discount from that charge. Purchasers of fleet vehicles have greater clout in negotiating discounts than do the buyers of a single vehicle. In the same way, large employers have greater purchasing power when buying insurance or negotiating health care discounts than do privately or self-insured individuals.
The average length of stay is another important measure which illustrates the cost and quality implications of a vaginal delivery compared to a C-section. The average length of hospitalization for a C-section was twice that for a vaginal delivery in Pennsylvania hospitals in 1995. A greater emphasis on reducing unnecessary repeat C-sections would reduce health care costs and enable mothers to return home sooner with their newborns.