Increase in Caesarean Deliveries after the Australian Private Health Insurance Incentive Policy Reforms

Abstract

Background The Australian Private Health Insurance Incentive (PHII) policy reforms implemented in 1997–2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA). Methods and Findings All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (−21.4 to −19.3) decrease in public birth rates, a 51% (45.1 to 56.4) increase in private birth rates, a 5% (−5.3 to −5.1) and 8% (−8.9 to −7.9) decrease in unassisted and assisted vaginal deliveries respectively, a 5% (−5.3 to −5.1) increase in caesarean sections with labour and 10% (8.0 to 11.7) increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0–3 days in hospital following birth decreased by 20% (−21.5 to −18.5), but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1). Conclusions Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.

The Australian Baby Bonus Maternity Payment and Birth Characteristics in Western Australia

“…In an attempt to address the decline in PHI memberships among the Australian population and thus relieve pressure on public hospitals the then Australian government introduced strong tax-incentives and penalties on PHI premiums if taken out after 30 years of age in 1997–2000 to encourage the uptake of PHI [18], [19]. Our previous findings showing a decline in birth rates for public patients and an increase in birth rates for private patients after 2000–2001 [20] support previous findings reporting that these policy reforms appear to have been successful in relieving the pressure on public hospitals, particularly among more affluent Australians [21]. According to our current findings however, it appears that the baby bonus introduction may have counteracted the success of the 1997–2000 policy reforms by increasing the pressure on Australian birthing public hospitals, particularly in outer regional and remote areas.…”

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

“…In Australia, women of childbearing age with private insurance would have increased the use of private obstetricians, leading to higher rates of CS. 54 In Ireland, the financial incentives in private insurance are similar and are associated with striking inequities in care. 55 Policy and research implications Increases in the cost of care and hospital charges have become central issues in policy discussion in the USA and elsewhere.…”

Fatores associados à cesariana entre primíparas adolescentes no Brasil, 2011-2012

“…In Australia, which has recently experienced a growth in caesarean births, a study shows that this trend is a result of private health insurance incentive policy reforms 21 . In a study carried out in Italy in 2011, Kambale 22 demonstrated that social factors are strong predictors of caesarean section.…”