Hospitals get paid EXTRA to poke you during childbirth!

[whomovedmychocolate]

Just picked this up from the homebirth email group and am a bit .

Apparently, in around 2006 the way hospitals are paid for birth services was changed from payments per woman to payments by results. This means there is a rate according to the 'service' provided to the labouring woman.

Payment by results
(PbR)
With a standard national price tariff for each procedure (in hospital).
They are divided into Health resource groups (HRG's)
In birth there are-

N06 Normal delivery with complications(£1464)
 N07 Normal delivery without complications (£863)
 N08 Assisted delivery wcc (£1746)
 N09 Assisted delivery wocc (£1205)
 N10 LSCS wcc(£2746)
 N11 LSCS wocc(£1986)
 N12 AN admission not related to delivery event(£473)

(LSCS - lower section caesarian section)

So yes, the hospitals get more money the more they poke you!

Without wishing to be very cynical, doesn't it seem remarkable that intervention rates are up? I know you have to reflect practitioner time but how did they come up with this charge schedule? 'So, I reckon it costs about £400 to get the forceps out'

Really? This isn't the costs of delivery?

Depends....what do you consider a complication?

A VBAC birth is a complicated birth, but does not necessarily require any extra effort on the part of the staff.

A birth involving high blood pressure is complicated, yet it affects a high percentage of women.

What is a cs without complications? Presumably a planned caesarian but if it's for twins or a repeat section, they are both complications.

I'm slightly dubious because it seems like there is no tangible financial reward for encouraging natural birth.

I can see your point, but the hospital aren't being paid more to poke you, they're being reimbursed the extra cost of your care.

I really don't think and individual obstetrician would do an op/ intervention simply because the hospital get paid more....this would be a clinical governance issue, and would be stamped on roundly by the professional bodies/ defence organisations.

Actually I know at least one obstetrician who thinks it's his duty to ensure childbirth is over as quickly as possible to reduce the risks as 'childbirth is only safe in retrospect'. (I'm not going to see him anymore, he scares me!)

I'm not saying they do it for the money, I'm saying that they are not incentivised to avoid intervention.

I'm sure hospitals used to get fined for doing too many sections (or did I dream that)? And now they get paid more?

get the conspiracy theory out of your head.

Hospitals set tariffs for everything they do when a patient is admitted. Just staying in hospital overnight costs approx £400, extras such as blood tests and other investigations are charged accordingly to your GP/Primary Care Trust. I think most PCTs are allowed a 'cap' on the maximum amount they can be charged for each admission/patient.

Nurses and junior doctors are almost completely unaware of the politics of tariffs.

Consultants? Well, depends really on how involved they are with the managerial running of a 'service'. DH set up a service so he is acutely aware of the finance of it all.

Be reassured that the only time it can become an issue is when the PCTs and Hospital Trusts fight with each other at a very senior level. PCTs have a cap on the max amount that Hospital Trusts can charge them/per patient admission, so PCTs will push for as many investigations as possible to be carried out when their patient is admitted. Hosp Trusts have the opposite view - they want to reduce the number of investigations per admission, and have the patient re-admitted so as to potentially increase the amount they can charge the PCTs.

DH, for example, is very thorough (but by no means an 'over investigator') and likes his patients completely sorted out in one admission. He has been pressurised by senior management to readmit patients to make the trust more money, but he wrote a strongly worded email to the Chief Exec and copied to all of the hospital's consultants, basically saying this policy was unethical and he would go to the GMC and DoH if they ever mentioned it again. Not a peep since then! {wink]

For your conspiracy theory to hold up, it would be the GPs pushing for labour interventions and the hospitals holding off to save them money.

It is true that normal birth isn't incentivised by PbR. But I am absolutely sure that clinical need & decisions are paramount when women are giving birth, not financial considerations. And it's hardly as if individuals get more money if they perform more interventions... The tariffs are currently under review btw.

More argument for homebirth ladies!!!

Agree with highlander whatever you think of individuals, docs and midwives are proffesionals who have in interest in bringing your baby into the world safely, and if we're looking for incentives any delivery with complications increases the length of hospital stay and IME the thing the hospitals try to do quickest is clear the bed.....

re the lack of incentivisation for natural labour and delivery, surely that could work both ways and suggest from the arguments above that just as someone who really did not need an assisted delivery for example could end up with one, a mother who would benefit from an intervention could be pushed (pardon the pun!) into labouring naturally when this wasn't the best thing for her or baby. Both situations are so subjective though it's hard to judge as it's down to how the mum feels about the process- maybe this situation (needing assistance but not getting it) just doesn't happen as often though, don't know.

I don't think however that all consultants and senior medical staff are hiding behind black cloaks muttering and plotting about how to con us women into getting a birth we don't want. Do recognise the argument though that the business side of running a hospital does not always appear to be matched with best patient care.

I don't think cost is ever considered in a cynical way, but when incentives are offered, for whatever reason, then sub-consciously our behaviour does take this into account

My experience is that if you are still in the hospital at shift changeover time, chances are interventions will be offered by the new team. I don't think it's cynical actually, I think a fresh pair of eyes will always want to do something to help.

Personally I'm having this baby at home if I'm well enough, I'm just terrified of scalpel happy docs these days.

There is lots of evidence that having one to one care from a midwife during labour can reduce the risk of a woman needing interventions.

At the moment hospitals tend to employ the lowest number of midwives they can get away with to keep their staff costs to a minimum. If employing more midwives costs them in salaries AND reduces the amount of money they get paid because fewer women will have complicated births, it's understandable why hospital managers may not be keen to recruit more midwives....

Hey, I was just wondering if you had a link to the original source of that information, or a reference as to where I could find it either online or IRL? I'd be really interested in following it up. Those costs are mad, aren't they? I would like to do a bit of research on it myself.

I hope you can point me in the right direction, whomovedmychocolate, I would have contacted you directly but I'm not signed up for that CAT thing!

It's not 'payment by results' at all! Obviously the caesarean (which needs more one-to-one staff and anaesthetists and longer stay in hospital etc) will COST more than an uncomplicated delivery. This is to do with reimbursing costs not incentivising anything. What is supposed to happen then? That hospitals only get the costs reimbursed if the birth is 'normal'? And doctors have to say "we can't give you that caesarean for your breech/placenta praevia baby because we won't get the costs back'?
A hospital will get paid more for a triple bypass than for a blood test. Doesn't mean that people will be given triple bypasses instead of blood tests!