Research Review: Money as Motivation for C-sections

C-section rates are high in the US, and higher in fat women.

NPR just released an article talking about a study that proposes the United States’ high cesarean section rate is at least partially motivated by money.  This is plausible, as c-sections tend to bring in more money to a doctor and hospital, take less time, can be scheduled, and it is far harder to get sued for intervening than for not intervening. Interventions as lawsuit-prevention is a common theme among rates of other interventions, too, like episiotomies, pitocin, and epidurals.

My issue comes with their methodology.  Unfortunately, the actual paper is behind a pay wall.  NPR’s coverage of it stated that the study found OB-GYNs preform fewer c-sections on doctors than patients who worked in other fields.  I don’t doubt that.  It concluded that because doctors (as patients) are better informed, they receive fewer unnecessary c-sections (unnecessarians, if you will). They make the analogy that mechanics pay lower repair fees and have fewer repairs on their cars.  The idea is that OB-GYNs are less likely to recommend unnecessary costly procedures to people who will knowingly refuse them.

I think that this study may have faulty logic and may not give enough consideration to confounding factors.  People who are poor, not white or Asian, have lower levels of education, and are fatterhave higher c-section rates.  The study doesn’t seem to account for the idea that doctors are, as a whole, the opposite of that demographic.  Doctors have achieved higher levels of education, are statistically far more likely to be white or Asian, they may not be rich but they are more affluent than average, and doctors are less likely to be fat.

Thus, just by their demographics, doctors are less likely to have a cesarean section.  I think it is important to identify why doctors receive fewer cesarean sections, as c-section rates are too high in this country and globally (Pgs. 25-26).  But the answer is likely more complicated than just their expertise, and we should strive to remedy all the areas of inequalities around receiving the best care possible, not just the ones that are easy to identify.