Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis

Abstract

ObjectiveFinancial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the first year of records through February 2016.Eligibility criteriaTo be eligible, studies had to report data to allow the calculation of ORs of CS comparing private for-profit hospitals with public or private non-profit hospitals in a specific geographic area.OutcomesThe prespecified primary outcome was the adjusted OR of births delivered by CS in private for-profit hospitals as compared with public or private non-profit hospitals; the prespecified secondary outcome was the crude OR of CS in private for-profit hospitals as compared with public or private non-profit hospitals.Results15 articles describing 17 separate studies in 4.1 million women were included. In a meta-analysis of 11 studies, the adjusted odds of delivery by CS was 1.41 higher in for-profit hospitals as compared with non-profit hospitals (95% CI 1.24 to 1.60) with no relevant heterogeneity between studies (τ2≤0.037). Findings were robust across subgroups of studies in stratified analyses. The meta-analysis of crude estimates from 16 studies revealed a somewhat more pronounced association (pooled OR 1.84, 95% CI 1.49 to 2.27) with moderate-to-high heterogeneity between studies (τ2≥0.179).ConclusionsCS are more likely to be performed by for-profit hospitals as compared with non-profit hospitals. This holds true regardless of women's risk and contextual factors such as country, year or study design. Since financial incentives are likely to play an important role, we recommend examination of incentive structures of for-profit hospitals to identify strategies that encourage appropriate provision of CS.

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

“…A recently published meta-analysis found that the odds of delivery by CS was 1.41 higher in for-profit hospitals as compared with non-profit hospitals (95% CI 1.24 to 1.60). 22 These findings were confirmed across subgroups (ie, such as country, year or study design) of studies in stratified analyses, indicating financial incentives may play an important role in such outcome. 22 We found three other recent meta-analyses that summarised CS studies and found a strong association with obesity, 43 sub-Saharan Africa ethnic origin 44 and labour induction.…”

“…22 These findings were confirmed across subgroups (ie, such as country, year or study design) of studies in stratified analyses, indicating financial incentives may play an important role in such outcome. 22 We found three other recent meta-analyses that summarised CS studies and found a strong association with obesity, 43 sub-Saharan Africa ethnic origin 44 and labour induction. 45 Our estimates of a 13% increase are on the lower end of the strength of associations found in earlier studies.…”

“…[14][15][16][17][18][19][20][21][22] We therefore performed a systematic review and meta-analysis to determine the association of insurance status of women with the odds of delivery by CS.…”

Hospital‐ownership status and cesareans in the United States: The effect of for‐profit hospitals

“…Women's health researchers increasingly recognize the importance of hospital characteristics on women's birth outcomes, specifically mode of delivery. For example, a recently published meta‐analysis of studies that spans several countries and years found that the odds of cesarean were 1.41 times higher in for‐profit hospitals compared with not‐for‐profit hospitals . However, the four United States‐based studies included in this meta‐analysis have limitations.…”

Does the Day of the Week Predict a Cesarean Section? A Statewide Analysis

“…Although this finding may be surprising, CS rates have been similarly observed to vary with other nonclinical factors. For example, hospital type (urban versus rural), 12 the age and sex of the physician, 9 and a hospital's financial incentive structures 13 have all been linked to an increased likelihood of performing CS. The impact of admission day on the rate of CS delivery has not been as extensively explored, although it has been observed in other surgical fields.…”