For the physician, this might be a loss of income from providing other kinds of care during the time labor is supervised. For the woman, this might be a loss of caregiving to other family members or a loss of wages or income due to an uncertain date of delivery. No published studies have assessed these opportunity costs from either the perspective of the patient or the caregiver. If financial costs are ignored, determinants of clinical decisions should include the probable outcomes achieved by the decision and the preferences of patients and clinicians for those various outcomes. Even before current efforts at health system reform, physicians have been well aware that the financial costs of clinical decisions play a significant role for many of their patients.
Several examples demonstrate the range of charges for maternity care.
The substantial drop in maternal length of stay for ERCS patients reflects recent national trends toward shorter hospitalization. In Oregon, the hospital lengths of stay for a cesarean section in 1991 and 1992 were on average 2.2 times greater than for a vaginal birth. In Florida, the hospital length of stay for a repeat cesarean section was 1.6 times that of a VBAC and the hospital charges closely paralleled the differences in lengths of stay. The reasons for these differences are poorly understood, but may be economically driven. The absence of cost-effectiveness data demonstrating a relationship between cesarean section rates and either costs or outcomes has prompted some payers to change reimbursement policies for child birth.