The number of hospital deliveries decreased 5.6% from 1993 to 1995. There were 151,105 babies delivered in Pennsylvania hospitals in 1995, with 30,489 delivered by Cesarean section (C-section) - a rate of 20.2%. This represents a decrease from 21.7% in 1993.
Healthy People 2000 - a project of the U.S. Department of Health and Human Services - advocates a national objective of a 15% C-section rate by the year 2000. If the C-section rate in Pennsylvania had been 15% in 1995, rather than 20.2%, there would have been approximately 7,800 fewer C-sections, at an estimated reduction of $28 million in hospital charges and 14,000 fewer days spent in the hospital in 1995.
Hospitals in Region 1 (Southwest PA) had the lowest C-section rate at 18.7%, while hospitals in Region 2 (Northwest PA) had the highest C-section rate at 22.1%.
The 1995 vaginal birth after a C-section (VBAC) rate in Pennsylvania was 35.1%, reaching the U.S. Department of Health and Human Services' national objective of a 35% VBAC rate by the year 2000. This was a substantial increase over the 1993 rate of 29.2%.
Pennsylvania hospitals in three regions reached or exceeded the Healthy People 2000 VBAC goal of 35% in 1995: The Region 1 (Southwest PA) rate was 40.2%; Region 9 (Philadelphia) was 38.7%; and Region 8 (suburban Philadelphia) was 35.0%. Hospitals in Region 3 (Altoona-Johnstown-Somerset area) had the lowest VBAC rate in 1995 at 27.4%.
The average hospital charge for a C-section delivery in 1995 was about $7,300, while the average charge for a vaginal delivery was $3,700. Both figures represent increases since 1993.
The average length of a hospital stay in 1995 for a vaginal delivery was 1.7 days and 3.5 days for a C-section delivery. These data represent a decline from 1993 figures.
Pennsylvania C-section charges totaled $209,447,400 in 1995, a decrease of 5.2% from 1993.
Payer Groups
Those enrolled in Medicaid Health Maintenance Organization (HMO) plans in 1995 had the lowest C-section rate of all payer groups at 17.2%. In 1993, the Medicaid program also had the lowest C-section rate. Medicaid's traditional fee-for-service plan had the second lowest rate at 18.4%. Blue Cross plans had the highest C-section rates in 1995, with their HMO plans at 21.7% and their fee-for-service plans at 21.6%.
In 1995, all payer groups exceeded the Healthy People 2000 national VBAC objective of 35%. Medicaid HMOs had the best VBAC rates among all payer groups at 46.8%.
While Medicaid HMO recipients were less likely to have a C-section and more likely to have a VBAC, they also had the longest average hospital stay at 3.8 days.
In general, fee-for-service plans (except Medicaid) had slightly shorter lengths of hospitalization than enrollees in HMO plans.
Payer groups in Region 1 (Southwest PA) had the lowest C-section rate at 18.5% and the second best VBAC rate at 42.4%. Payer groups in Region 9 (Philadelphia) had the best overall VBAC rate at 44.1%, with Medicaid HMOs leading the region with a 51.7% VBAC rate.
Payer groups in Region 9 (Philadelphia) had the longest C-section length of hospitalization at 3.9 days, while payer groups in Region 2 (Northwest PA) had the shortest C-section length of hospitalization at 3.2 days.
Medicaid plans represented nearly 40% of all deliveries in each of the following regions: Region 2 (Northeast PA), Region 3 (Altoona-Johnstown-Somerset area) and Region 9 (Philadelphia). Blue Cross plans represented 40% or more of all deliveries in each of the following regions: Region 1 (Southwest PA), Region 3 (Altoona-Johnstown-Somerset area), and Region 6 (Wilkes-Barre-Scranton area). Commercial plans represented 45% of all deliveries in Region 8 (suburban Philadelphia) and more than 30% in Region 4 (Williamsport-Bloomsburg area), Region 5 (Southcentral PA), Region 7 (Allentown-Reading area), and Region 9 (Philadelphia).
County and Community Rates
In 1995, C-section rates throughout Pennsylvania showed a wide variation, with rates by county ranging from 36.4% in Fulton County to 10.5% in Pike County. The C-section rates ranged even greater among selected communities, with 36.4% in the Ridgway area to 9.5% in the Honesdale area.
In general, residents of rural counties and communities tended to have the highest C-section rates. Of the 23 counties significantly above the statewide rate, 19 can be considered rural.
The following counties had C-section rates significantly above the statewide rate in both 1992 and 1995: Armstrong County, Bedford County, Bucks County, Carbon County, Clarion County, Clearfield County, Columbia County, Elk County, Franklin County, Fulton County, Jefferson County, Luzerne County, Lycoming County, Mifflin County, Northampton County, Schuylkill County, Snyder County, and Wyoming County.
The following communities had C-section rates significantly above the statewide rate in both 1992 and 1995: Bedford, Bensalem, Berwick, Chambersburg, DuBois, Easton, Huntingdon, Lewisburg, Lewistown, Kittanning, Philadelphia-Holmesburg, Pottsville, Saint Marys, Tunkhannock, and Wilkes-Barre South.
The following counties had C-section rates significantly below the statewide rate in both 1992 and 1995: Allegheny County, Chester County, Montgomery County, and York County.
The following communities had C-section rates significantly below the statewide rate in both 1992 and 1995: Braddock, Bryn Mawr, Monroeville, Paoli, Philadelphia-Fairhill, Philadelphia-Park East, Philadelphia-Spring Garden, Phoenixville, Pittsburgh-Central, Pittsburgh-Oakland, Titusville, Wilkinsburg, Willow Grove, and York.