Financial Reasons to Examine Unnecessary OB/GYN Procedures

From the HERS Foundation Gallery Web site


Right after leaving a comment on another blog about how one of the most commonly used arguments for leaving the Cesarean rate to settle where it may is that insurance companies and the government would rather save money than save women and babies, I stumbled on an article about unnecessary hysterectomies and c-sections taxing the system.

The February 4, 2009 article, Paying for the Bailout: How Unnecessary Medical Procedures Are Taxing the System, by Nora Coffey, president of the HERS Foundation, outlines how unnecessary procedures are taxing the system. Here are a few quotes from the article:


Evidence abounds that an increasing portion of our tax dollars that fund Medicare and Medicaid are the most lucrative revenue stream for the medical industry, and a large portion of those expenditures are going toward unnecessary, even harmful surgeries - not unquestionably-needed emergency care.

When a doctor and a hospital get involved in the natural process of childbirth, time is money.

The Centers for Disease Control and Prevention (CDC) report that more than 1/3 of American women have their female organs removed by the age of 60. The CDC also reports that the incidence of cancer in the female organs and the male organs is virtually identical, while the incidence of male organ removal is statistically insignificant.

What most people may not know is that HCA (Hospital Corporation of America) plead guilty to 14 felonies and was hit with a $1.7 billion fine – far and away the largest such fine in history - for Medicare fraud. These fines, it seems, were a minor bump in the road for HCA, on their way to grabbing hundreds of billions of American taxpayer dollars in the years to come. Doctors and hospitals reap the financial benefit of surgeries, whether they are warranted or not. American taxpayers, both in terms of Medicare/Medicaid payouts and higher insurance premiums, pay the real price.


At the beginning of the last Democratic president’s first term in office, a 1993 Healthfacts article entitled, “Unnecessary hysterectomy: the controversy that will not die,” discussed a study that scrutinized the “inappropriateness of hysterectomy” by comparing care in seven pre-paid health, or managed care, programs. The RAND Corporation conducted the study and published it in the Journal of the American Medical Association. The article notes that it is timely, considering that “the Clinton Administration is likely to give its blessing to a system called ‘managed competition.”

No doubt, a motivation for the comparison was the prevailing idea that our current fee-for-service medical care system invites abuse because of the physicians’ financial incentive to perform procedures. On the other hand, pre-paid medical groups where the physicians are on salary have been criticized for going to the other extreme: withholding care to save money. (If the managed competition idea catches on, we will all have to join a pre-paid medical group.)


Also mentioned in the article was a brief history of unjustified surgeries in the U.S.

As long ago as 1948, documented evidence indicated that hysterectomy was an over-performed operation. By the late 1960s, the emerging women’s movement helped to focus national attention on the subject, and in 1978, hysterectomy, along with tonsillectomy, became the central issue in a Congressional hearing on unnecessary surgery in the U.S.. The hearing brought to light the fact that there had been no well-designed studies to determine the appropriate indications for either operation, then the two most commonly performed surgical procedures.



Another anti-unnecessary hysterectomy activist, Robert Mendelsohn, dedicates an entire chapter of his 1981 book, Malepractice, to the procedure. Mendelsohn claims that of the 690,000 hysterectomies performed by American surgeons in 1979, no more than on in five could be justified as clinically necessary on the basis of life-threatening medical needs. According to Mendelson, “That means that more than half a million endured the operation for reasons that were frivolous at worst and dubious at best.”


After a 1977 congressional investigation on the hazards of the surgery, Mendelsohn reports that Dr. James H. Sammons, the principal spokesperson and executive vice-president of the American Medical Association employed the “blame the victim” strategy. His claim? That in “the increase in hysterectomies was due to their elective use as a ‘convenient form of sterilization’ and to their prophylactic use to eliminate the possibility of uterine cancer in future years.”



Convenience. Prophylaxis. Gives the illusion of eliminating the possibility that something could go wrong.  Familiar?



From Chapter 9, “What Do You Need a Uterus for, Anyway”:

When I confront a gynecologist with the staggering rise in the hysterectomy rate he almost always responds with the “blame the victim” excuse. It is remarkable how pliable doctors claim to be in the hands of their female patients when the result is income from non-diseases that they can treat. To hear them tell it, they simply can’t resist when patients plead for surgery they don’t need. Besides, the doctors maintain, it wouldn’t do any good to say “no,” because their patients would shop for another surgeon who is willing to do the job.


Mendelsohn continues:

I don’t believe that “popular demand” will explain away the fact that the United States has the highest hysterectomy rate in the world—two and one-half times that of England, and four times that of Sweden and some other European countries. A more reasonable explanation is the fact that those countries have state-paid health plans that remove the economic incentive to perform more surgery.



The study Comparison of a Trial of Labor with an Elective Second Cesarean Section, which appeared in the New England Journal of Medicine in September 1996, found that women with insurance were twice as likely to undergo Cesarean sections as uninsured women who give birth at public hospitals. This finding is not mentioned in the abstract.


Would this not suggest that doctors are more likely to perform a c-section on a woman with private insurance because they are more likely to be reimbursed at a higher rate?







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