Charges for comprehensive obstetric care at teaching and nonteaching hospitals. A comparison.
We compared total charges for obstetric care at a major teaching hospital and faculty group practice with those at 3 nonteaching centers in western Washington. The patients were all enrollees of an employee-based health maintenance organization. Charges were used as a proxy for costs and included all outpatient, inpatient, and physician charges. In the teaching system, patients were cared for by faculty and house staff; in the nonteaching settings, they received care from private physicians. No significant differences in total charges were found between the teaching and the nonteaching settings for all deliveries ($4,652 [N = 90] versus $4,530 [N = 335], P greater than .5). In the teaching setting, vaginal deliveries were slightly more expensive ($4,178 [n = 75] versus $3,768 [n = 250], P = .15), as were cesarean deliveries ($7,024 [n = 15] versus $6,771 [n = 85], P greater than .5). The rate of cesarean deliveries was lower in the teaching setting (17% versus 25%, P = .10), partially accounting for the similarity in total charges. The length of stay was similar in the teaching hospital (3.29 versus 3.14 days, P greater than .5). We conclude that the academic medical center as a total system of care can provide obstetric care as cost-effectively as nonteaching systems under the constraints of prepaid care.
Gordon
G S
GS
Department of Medicine, School of Medicine, University of Washington, Seattle.
Sefcik
S E
SE
Lo Gerfo
J P
JP
D002585:Cesarean Section / Q000191:economics; D005249:Fees and Charges / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009774:Obstetrics / Q000191:economics; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics*; D011247:Pregnancy; D014861:Washington