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Re: ?? C-Sections to 'Boost Hospital Profits' From: Eberhard W Lisse (el@ac.lisse.na) Sun Apr 8 13:49:38 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Belal Hossain: "Re: Pre-eclampsia in the news -- REPLY -- REPLY" Previous message: Marilyn Ringst: "Re: ?? C-Sections to 'Boost Hospital Profits'" Dan, Gary In message <B6F4DFBC.2AAC%jafar6@optonline.net>, jafar6 writes: > on 4/7/01 2:10 PM, Braun, R. Daniel at rbraun@iupui.edu wrote: >> What a crock of ___________. Sure there are a few jerks out there >> who might do a C/S to "make more money", but I think there are so >> few of them that it makes no diference in the long run. What car would those be driving? (I just couldn't resist :-)-O) >> And what few are there are doing it because of pressure from the >> OVERSUPPLY of OBGYN's. (Plus CNM's, midwives, Nurse practitioners, >> etc). IOW there are way too many people delivering babies compared >> to what is needed. Now I do wonder about this statement. If there was an oversupply, one would assume that all delivering women in the US got access to antenatal care, and thus that the perinatal mortality is better than it actually is. > I have heard of administrators trying to decrease cesarean rates as > part of a quality improvement plan. I really would like to find out where this nonsense of a section rate originates from. As far as I am concerned some high paid moron at the WHO in his plushy office has turned on the random number generator. > I have also heard (the same and other) administrators trying to make > sure that cesareans are done in a timely manner and when > necessary. The latter has come up after bad outcomes are presented > at peer review. No, this is just good business practice, decreases the liability and the less time you spend in court the more you have time to worry about your stock options. :-)-O > Some hospitals don't seem to address the issue of cesarean rates or > seem like they don't even care. Ask me to elaborate if you wish. Why should they address the issue of "rates"? I personally don't care at all. At least as long as we haven't come up with an evidence based one. And, please do elaborate. > I have never seen a hospital adequately develop an effective protocol to > optimize the rate and performance of cesarean sections. So, again, what is the OPTIMAL rate of cesarean sections? As long as you can't determine that you can't develop a protocol. > They try with physician profiling, peer review, encouraging > VBAC's. Their efforts seem as well directed as they do successful > (nada on both counts). In Germany they make it mandatory for all delivery units to fill in that questionaire adn then they like you to be as close as possible to the average or below. > I am curious if experts on this list in managed care or the insurance > industry could comment on priorities for cesarean delivery rates. So am I. > Cesareans are now acceptable in some circles for protection of > pelvic floor (in the absence of any history) and even patient > autonomy. Therefore, I wouldn't be surprised if somewhere out there > someone in a blue suit (with authority to command others) decided > that vaginal deliveries are not the way to go. Now of course the patient is the person to decide, but indicationless surgery is going put you in trouble if something goes wrong. And, remember, they have until College to decide that they want to become interested in your Porsche. > I find that cesareans are more economical to most practitioners > because of the time required to watch a patient in labor. Solo > practitioners without extensive backup might find that particularly > true. But to plan a method of delivery or an operation for financial > reasons is as unethical as one can get. In Namibia (and South Africa if I am not mistaken) they pay exactly the same for any delivery, but it hasn't dropped the private C/S rates much. el Next message: Belal Hossain: "Re: Pre-eclampsia in the news -- REPLY -- REPLY" Previous message: Marilyn Ringst: "Re: ?? C-Sections to 'Boost Hospital Profits'"

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