Evidence-based Birth Attendance in Spain: Private versus Public Centers

Abstract

The type of hospital (public or private) has been associated with the type of clinical practice carried out. The purpose of this study was to determine the association between the type of hospital (public or private) and delivery attendance with practices based on the recommendations by the World Health Organization (WHO). A cross-sectional study with puerperal women (n = 2906) was conducted in Spain during 2017. The crude Odds Ratios (OR), adjusted (aOR) and their 95% confidence intervals (CI) were calculated through binary logistic regression. For multiparous women in private centers, a higher rate of induced labor was observed (aOR: 1.49; 95% CI: 1.11–2.00), fewer natural methods were used to relieve pain (aOR: 0.51; 95% CI: 0.35–0.73), and increased odds of cesarean section (aOR: 2.50; 95% CI: 1.81–3.46) were found as compared to public hospitals. For primiparous women in private centers, a greater use of the epidural was observed (aOR: 1.57; 95% CI: 1.03–1.40), as well as an increased likelihood of instrumental birth (aOR: 1.53; 95% CI: 1.09–2.15) and of cesarean section (aOR: 1.77; 95% CI: 1.33–2.37) than in public hospitals. No differences were found in hospitalization times among women giving birth in public and private centers (p > 0.05). The World Health Organization birth attendance recommendations are more strictly followed in public hospitals than in private settings.

Obstetric factors associated with postpartum post‐traumatic stress disorder after spontaneous vaginal birth

“…The resulting sample population had a similar parity to that of general Spanish population and to other studies 34 . Participants gave birth mostly in public hospitals (81.1%), in agreement with the Ministry of Health of Spain's official statistics and other published studies 35,36 . Therefore, the study sample appears representative of the reference population.…”

The Equity of Health Care Spending in South Korea: Testing the Impact of Publicness

“…Little empirical research in the field of health care management has explored sectoral differences in diverse processes and outcomes of health care. Despite recent studies about the difference between public and nonpublic systems of health care [9][10][11][12], they have paid little attention to what characteristics are associated with the sectoral variances in health care outcomes. They have mainly focused on simple sectoral differences, rather than on specific sectoral variances of ownership, control, and evaluation.…”

“…Ownership status in health care organizations may involve different practices of cost management and control mechanisms in contracting out management [10]. In addition, hospital ownership may influence the type of clinical practice [11] and generate differences in health care like bariatric surgery [12]. More systematic review and analysis about specific sectoral differences in health care is required for a better understanding about how health equity varies from pubic and nonpublic hospitals.…”

Análisis multinivel del efecto del lugar de nacimiento en la proporción de partos por cesárea en Colombia

“…In Colombia, the proportion of Robson's groups differs between cities 13 , 15 , and the proportion of cesarean deliveries varies between departments 16 . In this regard, the influence of contextual factors on the mode of delivery have already been described, such as the public or private nature of the institution 17 , the limitation of specialized human resources, and contracting at differential rates 2 .…”

“…En Colombia, la proporción de los grupos de Robson difieren entre ciudades 13 , 15 , y la proporción de partos por cesárea varía entre los departamentos 16 . En este sentido, se ha descrito la influencia de factores contextuales en la vía del parto, como la naturaleza pública o privada de la institución 17 , la limitación del recurso humano especializado y la contratación con tarifas diferenciales 2 .…”