Caesarean sections and private insurance: systematic review and meta-analysis

Hoxha, Ilir; Syrogiannouli, Lamprini; Braha, Medina; Goodman, David C.; Costa, Bruno R. da; Jüni, Peter

doi:10.1136/bmjopen-2017-016600

Cited by 49 publications

(49 citation statements)

References 54 publications

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“…Our findings confirm the studies by Hoxha and colleagues [18][19][20] where they argue that women with private health insurance are more likely to undergo CS than those with public insurance or no insurance at all. Women with private/employer insurance have higher probability to have CS compared to those with no insurance cover (aRRR = 1.6064).…”

Section: Discussionsupporting

confidence: 92%

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Too Posh to Push: Determinants of Planned C-Section Delivery Among Indonesian Women

Prasetyoputra¹,

Sitohang²,

Rahadian³

et al. 2020

Proceedings of the 4th International Symposium on Health Research (ISHR 2019)

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Caesarean section (CS) delivery in Indonesia is on the rise and has drawn a considerable attention to its social determinants. However, information on planned CS delivery is limited in the Indonesian setting. Hence, this study aims at investigating its correlates. We employed data from the 2017 round of the Indonesian Demographic and Health Survey. The dependent variable is a nominal variable representing method of delivery (1 = natural, 2 = planned CS, 3 = unplanned CS). The explanatory variables comprise three groups, namely spatial, maternal, demographic, socioeconomic variables, and access to information. We fitted simple and multivariable multinomial logit models using relative risk ratio as the measure of association. After selecting facility births only and deleting missing cases, we analysed an analytic sample of 12,225 births. Of those births we observed 22.89% were done by CS. There were slight differences related to region of residence and urban residence for both planned and unplanned CS. Higher maternal age corresponds with higher risks of both planned and unplanned CS. Complication during pregnancy was found to increase the risk of planned CS. Moreover, access to internet increases the probability of having planned and unplanned CS delivery. Furthermore, ownership of private insurance and affluence are strongly associated with planned CS delivery. These findings suggest an indication of unnecessary CS deliveries that consume resources that could otherwise be used for other health needs. Educating expectant mothers and families on the benefits of natural birth could reduce the planned c-section rates in Indonesia and save health resources.

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Section: Discussionsupporting

confidence: 92%

“…As for the potential explanatory variables, we selected them based on previous literature [11,[17][18][19][20][21][22][23][24][25][26][27]. We categorized them into several groups, namely spatial variables, maternal variables, demographic variables, access to information, and socio-economic variables.…”

Section: Variables Selectionmentioning

confidence: 99%

Too Posh to Push: Determinants of Planned C-Section Delivery Among Indonesian Women

Prasetyoputra¹,

Sitohang²,

Rahadian³

et al. 2020

Proceedings of the 4th International Symposium on Health Research (ISHR 2019)

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“…Insurance coverage is one of the health system factors known to influence the use of medical procedures,15 16 including CS 17–20. While private insurance, for example, seems to increase the odds of having a CS delivery,17 the lack of insurance appears to decrease it 20–22.…”

Section: Introductionmentioning

confidence: 99%

Caesarean section in uninsured women in the USA: systematic review and meta-analysis

Hoxha

Braha²,

Syrogiannouli

et al. 2019

BMJ Open

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ObjectiveThe aim of this study is to assess the odds of caesarean section (CS) for uninsured women in the USA and understand the underlying mechanisms as well as consequences of lower use.Study designSystematic review and meta-analysis.Data sourcesPubMed, Embase, the Cochrane Library and CINAHL from the first year of records to April 2018.Eligibility criteriaWe included studies that reported data to allow the calculation of ORs of CS of uninsured as compared with insured women.OutcomesThe prespecified primary outcome was the adjusted OR of deliveries by CS of uninsured women as compared with privately or publicly insured women. The prespecified secondary outcome was the crude OR of deliveries by CS of uninsured women as compared with insured women.Results12 articles describing 16 separate studies involving more than 8.8 million women were included in this study. We found: 0.70 times lower odds of CS in uninsured as compared with privately insured women (95% CI 0.63 to 0.78), with no relevant heterogeneity between studies (τ2=0.01); and 0.92 times lower odds for CS in uninsured as compared with publicly insured women (95% CI 0.80 to 1.07), with no relevant heterogeneity between studies (τ2=0.02). We found 0.70 times lower odds in uninsured as compared with privately and publicly insured women (95% CI 0.69 to 0.72).ConclusionsCSs are less likely to be performed in uninsured women as compared with insured women. While the higher rates for CS among privately insured women can be explained with financial incentives associated with private insurance, the lower odds among uninsured women draw attention at barriers to access for delivery care. In many regions, the rates for uninsured women are above, close or below the benchmarks for appropriate CS rates and could imply both, underuse and overuse.

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“…Beyond the adverse outcomes concerning equity and the doubtful gains in efficiency, private provision and finance of healthcare can result in unnecessary, and sometimes harmful, cases of overtreatment. A systematic review of 21 studies [21] found that the odds of a Caesarean section (C-section) being performed was significantly higher in relation to women with private health insurance compared with women using public health insurance. In Chile, for example, three out of four publicly insured women who opt to give birth in a private hospital will have a C-section, while in public hospitals only one out of four women will undergo this procedure [22,23].…”

Section: Introductionmentioning

confidence: 99%

From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases

Filc

Rasooly

Davidovitch

2020

Isr J Health Policy Res

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Background: Different forms of public/private mix have become a central mode of the privatization of healthcare, in both financing and provision. The present article compares the processes of these public/private amalgams in healthcare in Spain and Israel in order to better understand current developments in the privatization of healthcare. Main text: While in both Spain and Israel combinations between the public and the private sectors have become the main forms of privatization, the concrete institutional forms differ. In Spain, these institutional forms maintain relatively clear boundaries between the private and the public sectors. In Israel, the main forms of public/private mix have blurred such boundaries: nonprofit health funds sell private insurance; public nonprofit health funds own private for-profit hospitals; and public hospitals sell private services. Conclusions: Comparison of the processes of privatization of healthcare in Spain and Israel shows their variegated characters. It reveals the active role played by national and regional state apparatuses as initiators and supporters of healthcare reforms that have adopted different forms of public/private mix. While in Israel, until recently, these processes have been perceived as mainly technical, in Spain they have created deep political rifts within both the medical community and the public. The present article contains lessons each country can learn from the other, to be adapted in each one's local context: The failure of the Alzira model in Spain warns us of the problems of forprofit HMOs and the Israeli private private/public mix shows the risk of eroding trust in the public system, thus reinforcing market failures and inefficient medical systems.

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Caesarean sections and private insurance: systematic review and meta-analysis

Cited by 49 publications

References 54 publications

Too Posh to Push: Determinants of Planned C-Section Delivery Among Indonesian Women

Too Posh to Push: Determinants of Planned C-Section Delivery Among Indonesian Women

Caesarean section in uninsured women in the USA: systematic review and meta-analysis

From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases

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