``Patient-Choice'' C-Section Rate Rises 36%: HealthGrades Study; More Women Choosing C-Sections When No Medical Necessity Exists; Florida, New York, New Jersey Have Highest Rates; Nevada, Washington, Florida Increase Most.

GOLDEN, Colo. -- C-Section Data Part of 2005 Ratings of Maternity Care at 1,500 Hospitals Available Free to Consumers at HealthGrades.com

The number of pregnant women choosing to have a "patient-choice" Cesarean section (C-section) rose by 36.6 percent from 2001 to 2003, according to a study released today by HealthGrades, the leading provider of independent healthcare ratings. The study also finds wide variation from state to state in the rate of these types of C-sections, for which there is no medical necessity.

Complication rates from "patient-choice" C-sections are one factor in the ratings of maternity care at more than 1,500 hospitals, which HealthGrades posts free of charge for consumers at www.healthgrades.com. The ratings are designed to let women compare the quality of maternity care among local hospitals.

Dr. Samantha Collier, HealthGrades' vice president of medical affairs and the author of the study, said, "The controversy over 'patient-choice' C-sections continues in the medical community, with some doctors believing that patients should have the ability to choose a C-section if they prefer. Other doctors believe that patients can never fully understand the risks involved, and should never choose major surgery when it is not necessary. Despite the controversy, this much is clear: the 'patient-choice' C-section rate in America has accelerated in each of the three years HealthGrades has been conducting this study, so consumers are making their preferences known."

The rise of 36.6 percent in the nation's "patient-choice" C-section rate represents an increase from 1.9 percent to 2.6 percent of deliveries in the years 2001, 2002 and 2003 for women with no history of C-sections. The study covers deliveries in the 17 states that release this data. When extrapolated to the nation, the study shows that 267,340 "patient-choice" C-sections were performed over those three years. These 17 states represent approximately 58 percent of the nation's total population.

The study finds that the rate of "patient-choice" C-sections varies widely from state to state. Arizona had the smallest increase, with 15.7 percent, while Nevada had the largest increase of 56.7 percent. As in past HealthGrades studies, Florida, New York and New Jersey had the highest rates of "patient-choice" C-sections in the latest year studied, 2003. The rates and percentage increase of the rate from 2001 to 2003 are in the following table:

Percent Increase of "Patient-Choice" C-Sections by State
                             (2001 - 2003)

State                           % Increase          2001         2003
----------------------------------------------------------------------
National                             36.56          1.87         2.55

Nevada                               56.74          1.94         3.04
Washington                           53.57          1.15         1.77
Florida                              47.55          2.21         3.26
Maine                                46.80          1.40         2.06
New Jersey                           45.63          2.14         3.12
Massachusetts                        45.00          1.86         2.70
Virginia                             43.52          1.96         2.84
Wisconsin                            42.54          1.04         1.48
California                           40.29          1.58         2.21
Utah                                 35.46          1.06         1.44
Texas                                33.13          2.15         2.86
Pennsylvania                         31.55          1.81         2.39
North Carolina                       31.41          1.89         2.48
Maryland                             29.15          1.76         2.28
Iowa                                 28.20          1.56         2.00
New York                             26.25          2.48         3.13
Arizona                              15.66          1.57         1.81

"When we first did this study three years ago, we found that 'patient-choice' C-sections were increasing at a rate of 19 percent, between 1999 and 2001," continued Dr. Collier. "Now we are seeing the rate increase by 36.6 percent between 2001 and 2003, a dramatic acceleration that we believe is driven by heightened awareness of the option, increased support and advocacy, and women waiting until they are older to have their first child."

Since the release of HealthGrades' first study on this topic in 2003, the American College of Obstetricians and Gynecologists' Ethics Committee released an opinion supporting C-sections by patient choice "...so long as the patient is fully informed of the risks and benefits of this procedure over vaginal delivery."

The full study, along with its methodology, can be found at http://www.healthgrades.com.

HealthGrades' Maternity Ratings for Consumers

For consumers, HealthGrades released on its Web site the 2005 Maternity Care ratings for more than 1,500 hospitals in 17 states. Updated annually and available for free, the ratings let women compare the quality of their local hospitals' maternity care. Each hospital receives a five-star, three-star or one-star rating of their maternity care based on the following criteria: obstetric volume, overall complication rates, "patient-choice" C-section complication rates, presence of a newborn intensive care unit, and newborn mortality rates. Unlike HealthGrades' other hospital ratings, which cover virtually every hospital in the country, the Maternity Care ratings are limited by the number of states that collect this data and make it available publicly.

About HealthGrades

HealthGrades (Nasdaq:HGRD) is the leading healthcare ratings company, providing ratings and profiles of hospitals, physicians and nursing homes to consumers, corporations, health plans and hospitals. Millions of consumers and hundreds of the nation's largest employers, health plans and hospitals rely on HealthGrades' independent ratings to make healthcare decisions based on the quality of care. More information on the company can be found at http://www.healthgrades.com.

Editors note: A full copy of the study is available at www.healthgrades.com.