“A Modest Proposal”: Universal Cesarean Section to Reduce Professional Liability Costs


ABSTRACT OBJECTIVE: To model the effect of universal cesarean delivery on professional liability costs.

STUDY DESIGN: We examined all obstetric professional liability claims covered by a single insurer between January 1, 1990 and December 31, 2000. We reviewed each case to determine if an alternate route of delivery might reasonably have prevented the lawsuit. Costs were calculated by adding the cost of processing the claim, the legal defense, the settlement payments and/or the actuarially derived adjustments. Using a 20% cesarean rate as our baseline, we modeled the effect on liability costs of cesarean delivery in all patients.

RESULTS: There were 205,241 births during the study period, and 91 lawsuits (incidence 4.4 per 10,000) were initiated with projected claims-costs totaling $53,731,903 ($590,460 per case). Among those 68 cases in which route of delivery may have affected outcome, we estimated $39,070,661 might have been saved if 63 cases had delivered by planned cesarean and $804,486 in claims-costs might have been saved if 5 patients had delivered vaginally rather than by cesarean. Finally, we identified 23 cases with costs of $10,638,797 in which the route of delivery would not have affected the outcome. With this model of universal cesarean section, the projected number of lawsuits decreases from 91 to 48 (a 53% reduction) and the cost to insurers drops to $14,661,242 ($305,442 per case); a potential savings of $39,070,661 (72.7%).

CONCLUSIONS: In the current legal environment, a policy of 100% cesarean sections could hypothetically reduce professional liability costs by 73%. We do not propose such a policy because it would subject a majority of patients to medically unindicated surgery.


Health Law and Policy | Medical Jurisprudence

Date of this Version

January 2006