Hospital variation in cost of childbirth and contributing factors: a cross‐sectional study

Objective To examine hospital variation in cost of childbirth hospitalizations and identify factors that contribute to the variation. Design Cross-sectional analysis of linked birth certificate and hospital discharge data. Setting 220 hospitals in California delivering ≥100 births per year. Population 405,908 nulliparous term singleton vertex births during 2010-2012. Methods Cost of childbirth hospitalizations was compared across hospitals after accounting for differences in patient clinical risk factors. Relative contribution of patient sociodemographic, obstetric intervention, birth attendant, and institutional characteristics to variation in cost was assessed by further adjusting for these factors in hierarchical generalized linear models. Main Outcome Measures Cost of childbirth hospitalization. Results Median risk-standardized cost of childbirth was $7,149 among the hospitals (10th-90th percentile range: $4,760-$10,644). Maternal sociodemographic characteristics and type of birth attendant did not explain hospital variation in cost. Adjustment for obstetric interventions overall reduced within-hospital variance by 15.8% (P