Associação entre a remuneração da assistência ao parto e a prevalência de cesariana em maternidades do Rio de Janeiro: uma revisão da hipótese de Carlos Gentile de Mello

Abstract

The purpose of this study was to compare prevalence of cesarean sections in nine private maternity hospitals in the city of Rio de Janeiro in 1968 and 1993, seeking to correlate the form of payment with prevalence of cesareans. We analyzed 3,413 deliveries in 1968 in nine maternity hospitals, at a time when a form of payment called "per service unit" was used. Twenty-five years later, these same maternity hospitals were reanalyzed, with a total of 11,065 births. These data were from Gentile de Mello (1968) and the Report from the Information System on Live Births, by the Rio de janeiro Municipal Health Secretariat. We performed a statistical analysis on the proportion of cesareans comparing the two years and observed a statistically significant increase in their prevalence in 1993 as compared to 1968, although payment was nearly equal for childbirth care in the two years. The elimination of the "per service unit" payment system and the implementation of equal payment for transvaginal and cesarean deliveries proved insufficient to decrease the prevalence of cesareans. We suggest that form of payment alone does not determine the high prevalence of cesarean sections, and that other variables are impacting this phenomenon.

Escolha da via de parto: expectativa de gestantes e obstetras

“…Estudo elaborado por Ferrari 5 encontrou que, diante da gestante que pleiteia a cesariana eletiva, 8,1% dos obstetras concordavam de imediato, 62,9% concordavam após discutir o caso, 17,7% discordavam e 11,3% não responderam -dados que corroboram com os resultados da presente pesquisa. Não há evidências de que a remuneração dos procedimentos influencie na escolha da via de parto pelo médico 11 , embora existam opiniões contrárias 12 .…”

Significant differences in cesarean section rates between a private and a public hospital in Brazil

“…The greater proportion of adolescent mothers observed at the public maternity agrees with published data, with a higher frequency of births among adolescents of less privileged classes 17 . The absence of an association between cesarean section and maternal schooling may be related to the low variability of schooling among mothers from the two groups, since this association has been well documented in Brazil, where only 13% of uneducated women have a history of cesarean delivery compared to 81% of women with higher education 18,19 .…”

“…Only one doctor monitors the pregnancy and performs the delivery, usually with a large number of visits (more than six), a fact that greatly strengthens the tie 8 . In addition, this type of delivery can be transformed into a consumption item that is accessible according to the patient's purchasing power, a fact that explains its prevalence among the higher income social strata, although with lower obstetrical risk 11,18,20 . This observation is reinforced if we consider that in Brazil, side by side with the high prevalence of cesarean deliveries, there are high maternal mortality rates 2 , with an average of 60 deaths/100,000 liveborns according to the Brazilian Ministry of Health (Departamento de Informática do SUS.…”

Consumo de medicamentos no período de internação para o parto

“…2,3,10,15 Em São Paulo, a taxa de partos cesáreos era de 53,4% em 1992, 10 e na região de São José do Rio Preto e em Ribeirão Preto, no período de 1986 a 1995, 10,15 de 80,5% e 48,8%, respectivamente. Nesse último observou-se crescimento da incidência de cesáreas nas categorias privada e pré-pagamento, e redução na categoria SUS, taxas inversamente proporcionais ao risco esperado do parto.…”