title: Reducing cesarean delivery rates in managed care organizations.
abstract: BACKGROUND
  A national consensus has emerged that cesarean delivery (CD) rates are excessive.
  
  
  OBJECTIVE
  To review the subject of CD delivery and to discuss options for reducing CD delivery rates in managed care organizations (MCOs) from the current rate of approximately 22% to a rate of 10% to 15% in 5 years, as proposed by the World Health Organization.
  
  
  METHODS
  Literature review.
  
  
  RESULTS
  Contracted physicians could be provided with evidence-based clinical practice guidelines for CD as well as data on acuity-adjusted physician-specific CD rates within the MCO and could be offered supplementary fees for performing vaginal deliveries after a previous CD. Administrators and physician leaders of contracted hospitals could also be asked to adopt written criteria for lack of progress in labor, to review all indications for CD for all cases, to encourage use of vaginal delivery after a previous CD, and to require a second opinion for performing all except emergency CDs. Members of MCOs who become pregnant could be mailed an educational pamphlet that encourages vaginal delivery rather than CD.
  
  
  CONCLUSIONS
  To facilitate dissemination of information, MCOs should report their experience in implementing, monitoring, and evaluating the effectiveness and outcomes of programs to reduce CD delivery rates. The MCO objective would be to lower CD rates without alienating physicians or attempting to impose a regimented approach that would offend and be counterproductive for consumers.
authors.affiliation: Institute of Epidemiology and Health Services Research, Jackson State University, MS 39213, USA. anthony.r.mawson@jsums.edu
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Mawson
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D007255:Information Services; D008329:Managed Care Programs / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D017749:Total Quality Management / Q000379:methods*; D014481:United States; D019564:Unnecessary Procedures; D016064:Vaginal Birth after Cesarean