• amytuteurmd

    This study shows exactly the opposite of what Johnson claims. The association between the status of hospitals and their C-section rates is so weak as to demonstrate that there is no connection at all.

    Take smoking and lung cancer, for example. Smoking increases the risk of lung cancer by more than 2000%. How about homebirths? Homebirth advocates are fond of claiming that the increased risk of neonatal death at homebirth is trivial, but CDC statistics indicate that it is in the range of 200%. In contrast, a 17% increase in C-section rate between for profit and not for profit hospitals is so small as to indicate that there is no relationship at all.

    And that doesn’t even address the fundamental flaws in the actual analysis. First, the risk status of patients in hospitals may differ between for profit and not for profit hospitals in ways that were not taken into account in the analysis. Second, Johnson himself found that there was no correlation between the volume of high paying vs. low paying patients and the C-section rate. If profit were driving an increased C-section rate, hospitals that have more indigent and non-paying patients should have lower C-section rates, but they do not. Third, and perhaps most important, Johnson did not demonstrate any connection between the profit status of the hospital and the profitability of C-sections. His entire analysis rests on the assumption that hospitals make more money for C-sections, but there is no set rate for reimbursement for obstetric care. Hospitals make contracts with individual insurers that provide different compensation for the same procedures. Depending on the specific contracts, C-sections might be profitable if the patient carries insurance from Company A, but unprofitable if the patient carries insurance from Company B. Profitability depends entirely on whether the compensation for the procedure defrays the costs incurred for that procedure. Depending on the specific reimbursement rate, a C-section could actually be less profitable than a vaginal delivery, because a C-section requires far more resources.

    The bottom line is this: California Watch did NOT demonstrate an association between profit status and C-section rates. In fact, Nathanael Johnson’s analysis for California hospital C-section rates demonstrates exactly the opposite. A 17% increase in C-sections is so small as to be meaningless. In other words, Johnson demonstrated that there is NO association between profit status and C-section rate.

  • julie-watkins

    Two times a small number is still a small number! That hasn’t changed.

    Homebirth advocates are fond of claiming that the increased risk of neonatal death at homebirth is trivial, but CDC statistics indicate that it is in the range of 200%. In contrast, a 17% increase in C-section rate between for profit and not for profit hospitals is so small as to indicate that there is no relationship at all.

    Apples & spinach. If someting happens infrienquently, doubling the risk means it might happen 2 in 100 times instead of 1 in 100 times. If a 17% increase of cesareans vs vaginal births — since it’s only one or the other — then it’s (for instance) 35 cesareans instead of 30, when the optimal is 15 per hundred? Am I remembering right? Anyway, you’re equating two different types of measures just casts doubt on the rest of your analysis.

    You’re so hungup on homebirths that you’ll bring it up at any excuse. Funny. So, now I get to point this out again: If, ballpark, a normal hospital birth is $15 K — or $40 K if the doctors decide on a cesarean (and the evidence seems to be there are many unnessary ceseareans) and if a homebirth midwife is $6 K (and her record is very good outcomes & few referrals to the local hospital), and if $15 K will risk lossing your home & $40K will make homelessness a certainty, then it’s logical for a pregnant woman to plan for a homebirth. IE, if the risk of bad complication is 1% (& I think it’s less than that) & the risk of becoming homless is 20%-100% (ie: 1 in 100 vs. 1 in 5 or 1 in 1 (for certain)), attempted homebirth is logical.

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