AssociationBetweenTypeofHealthInsuranceand ElectiveCesareanDeliveries:NewJersey,2004-2007

0.91) or self-paying (ARR=0.81; 95% CI=0.78, 0.85) had a significantly lower likelihood, and women insured by BlueCross (ARR=1.06; 95% CI=1.03, 1.09) or standard commercial plans (ARR=1.06; 95% CI=1.02, 1.10) had a significantly higher likelihood of cesarean delivery than did women insured by commercial health maintenance organizations. These associations persisted in subsets restricted to lower-risk women and in qualitative sensitivity analyses for a hypothetical single, binary, unmeasured confounder. Conclusions. Insurance status has a small, independent impact on whether a woman without a previous cesarean delivery proceeds to labor or has a cesarean delivery without labor. (Am J Public Health. 2011;101:e1‐e7. doi:10.

[1]  Sean F. Ennis,et al.  Physician Incentives and the Timing of Cesarean Sections:: Evidence From California , 2001, Medical care.

[2]  A. Fink,et al.  Vaginal birth after cesarean: clinical risk factors associated with adverse outcome. , 2008, American journal of obstetrics and gynecology.

[3]  K J Rothman,et al.  No Adjustments Are Needed for Multiple Comparisons , 1990, Epidemiology.

[4]  D. Lezotte,et al.  Neonatal Outcomes After Elective Cesarean Delivery , 2009, Obstetrics and gynecology.

[5]  D. Studdert,et al.  Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section , 2009, Medical care.

[6]  K. Gregory,et al.  Variation in elective primary cesarean delivery by patient and hospital factors. , 2001, American journal of obstetrics and gynecology.

[7]  S Greenland,et al.  Basic methods for sensitivity analysis of biases. , 1996, International journal of epidemiology.

[8]  J. Gornbein,et al.  Using administrative data to identify indications for elective primary cesarean delivery. , 2002, Health services research.

[9]  F. Chervenak,et al.  Elective primary cesarean delivery. , 2003, The New England journal of medicine.

[10]  J. Neilson,et al.  Caesarean section for non-medical reasons at term. , 2012, The Cochrane database of systematic reviews.

[11]  K. Tanfer,et al.  Primary Cesarean Deliveries Prior to Labor in the United States, 1979–2004 , 2008, Maternal and Child Health Journal.

[12]  K. Gregory,et al.  Age and racial/ethnic differences in maternal, fetal, and placental conditions in laboring patients. , 2003, American journal of obstetrics and gynecology.

[13]  J. Parker,et al.  Contribution of excess weight gain during pregnancy and macrosomia to the cesarean delivery rate, 1990-2000. , 2003, Pediatrics.

[14]  C. Gardella,et al.  Repeat cesarean delivery: what indications are recorded in the medical chart? , 2006, Birth.

[15]  S. Lee,et al.  Declining fertility and the use of cesarean delivery: evidence from a population-based study in Taiwan. , 2010, Health services research.

[16]  H. S. Brown.  Lawsuit activity, defensive medicine, and small area variation: the case of cesarean sections revisited , 2007, Health Economics, Policy and Law.

[17]  F. Menacker,et al.  Maternal risk profiles and the primary cesarean rate in the United States, 1991-2002. , 2006, American journal of public health.

[18]  M. Katz,et al.  Abnormal fetal heart rate tracing patterns during the first stage of labor: effect on perinatal outcome. , 2001, American journal of obstetrics and gynecology.

[19]  J. Zhang,et al.  What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. , 1998, JAMA.

[20]  Kosali Simon,et al.  Patient education and the impact of new medical research. , 2009, Journal of health economics.

[21]  Cesarean Delivery on Maternal Request: Obstetrician–Gynecologists’ Knowledge, Perception, and Practice Patterns , 2007, Obstetrics and gynecology.

[22]  J. Gornbein,et al.  Rethinking the Cesarean Rate: How Pregnancy Complications May Affect Interhospital Comparisons , 2005, Medical care.

[23]  R. Kirby,et al.  Obesity as a Risk Factor for Cesarean in a Low‐Risk Population , 2001, Obstetrics and gynecology.

[24]  Arpit Misra.  Impact of the HealthChoice Program on Cesarean Section and Vaginal Birth after C-Section Deliveries: A Retrospective Analysis , 2008, Maternal and Child Health Journal.

[25]  M. Wagner.  Choosing caesarean section , 2000, The Lancet.

[26]  D. Savitz,et al.  Incremental Charges, Costs, and Length of Stay Associated With Obesity as a Secondary Diagnosis Among Pregnant Women , 2009, Medical care.

[27]  C. Steiner,et al.  A National Estimate of the Elective Primary Cesarean Delivery Rate , 2005, Obstetrics and gynecology.

[28]  Dina Mayzlin,et al.  Physician Fees and Procedure Intensity: the Case of Cesarean Delivery , 1998, Journal of health economics.

[29]  D. Wirtschafter,et al.  Why pay extra for cesarean-section deliveries? , 1993, Inquiry : a journal of medical care organization, provision and financing.

[30]  C. Hobel,et al.  Using ICD-9 codes to identify indications for primary and repeat cesarean sections: agreement with clinical records. , 1995, American Journal of Public Health.

[31]  E. Keeler,et al.  Economic incentives in the choice between vaginal delivery and cesarean section. , 1993, The Milbank quarterly.

[32]  A. Daltveit,et al.  What characterizes women in Norway who wish to have a caesarean section? , 2009, Scandinavian journal of public health.

[33]  K. Tanfer,et al.  Trends in Maternal Request Cesarean Delivery From 1991 to 2004 , 2006, Obstetrics and gynecology.

[34]  K. Rothenberg.  National Institutes of Health State-of-the-Science Conference Statement: Cesarean Delivery on Maternal Request , 2006 .

[35]  J. Skinner,et al.  Fostering accountable health care: moving forward in medicare. , 2009, Health affairs.

[36]  H. Lawrence,et al.  Rising Cesarean Delivery Rates: The Impact of Cesarean Delivery on Maternal Request , 2009, Obstetrical & gynecological survey.

[37]  Susan R Miesnik,et al.  A review of issues surrounding medically elective cesarean delivery. , 2007, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.