Policy & Practice


Cesarean Rate Jumps 38% in U.S.

The number of babies delivered by cesarean section at U.S. community hospitals increased 38% between 1997 and 2003, according to a report from the Agency for Healthcare Research and Quality. More than one-quarter of the 4 million births that occurred in U.S. hospitals in 2003 were by cesarean section, compared with about one-fifth in 1997. The proportion of cesarean sections that are elective also is increasing, according to the report, which relied on data from the Healthcare Cost and Utilization Project. National charges associated with cesarean births were more than $14.5 billion in 2003, with 53% of the bill going to private payers and 41% being charged to Medicaid. The charges for an uncomplicated cesarean delivery averaged about $11,500, about $5,000 more than a routine vaginal delivery. The report also noted that vaginal birth after cesarean (VBAC) decreased by more than 60% from 1997 to 2003. The rate of VBAC was 35.3 per 100 women who had a previous cesarean in 1997 and dropped to 13.7 per 100 women in 2003. During the same period, the use of episiotomies and forceps during vaginal birth also dropped. The full analysis is available online at

Oral Contraceptives' Clinic Prices Cut

After an initial decision to raise prices of oral contraceptives earlier this summer, Ortho-McNeil has agreed to lower prices for the products for federally funded health clinics across the country. The company raised prices in July for various oral contraceptive products, inciting “widespread panic” among public health clinics, according to Marilyn Keefe, interim CEO of the National Family Planning and Reproductive Health Association. After hearing about the impact the price hike would have on the approximately 4,500 public health clinics nationwide, Ortho-McNeil announced at the end of August that it would drop its prices. “While the company has consistently followed a mandated formula to public health services as a result of participation in the federal government's Medicaid program, the organization has decided to further lower pricing to meet the needs of women and insure access to contraceptive choices and work with underfunded public health services,” Ortho-McNeil said in a statement. The new prices are 92%–94% discounted from the list price of the drugs, Ms. Keefe said.

U.S. Cancer Deaths Continue to Drop

Overall cancer death rates in the United States are continuing a nearly decade-long decline, according to an annual report on cancer trends released by the American Cancer Society, the National Institutes of Health, and other groups. The findings, which were to be published in the Oct. 15 issue of Cancer, included cancer incidence and trend data from 1975 to 2003. The study showed that the overall cancer incidence rates among all races and genders were stable from 1992 to 2003. However, the overall cancer incidence rates for men were stable from 1995 to 2003, while cancer rates in women were on the rise from 1979 through 2003. The report is available online at

Scales Influence Smoking Cessation

Pregnant ex-smokers who have confidence in their ability to control their weight are less likely to start smoking again after pregnancy, according to a new study published in the Annals of Behavioral Medicine. Researchers found that weight self-efficacy was significantly associated with postpartum motivation not to smoke even after controlling for other factors such as breastfeeding, partner smoking, years of smoking, race, and prepregnancy nicotine dependence. The study included 119 women in their third trimester of pregnancy. All of the participants were not smoking at the time of the study, but had smoked at least eight cigarettes per day for 1 month or more before becoming pregnant. The findings indicate that smoking cessation programs that target women's perceptions about weight gain may be able to improve long-term quitting success, the researchers wrote.

Poll: 70% Unaware of Medicare Cuts

About 70% of Americans recently polled were unaware of scheduled cuts to physician payments under Medicare, according to the American Medical Association. The group commissioned a poll of U.S. adults in an effort to draw attention to the planned 5.1% Medicare payment cut set to take effect in 2007 and additional payment cuts planned over the next several years. The telephone survey, conducted in July, polled more than 1,000 adults in the United States. When told about the scheduled cuts to physician pay, 86% of those surveyed said they were concerned the cuts could affect seniors' access to health care. The AMA is pushing Congress to take action this year to stop the 2007 cut from going into effect.

Next Article: