Estimating the differences in Caesarean section (C-section) rates between public and privately insured mothers in Florida: A decomposition approach

Abstract

Background Caesarean section (C-sections) is a medically critical and often life-saving procedure for prevention of childbirth complications. However, there are reports of its overuse, especially in women covered by private insurance as compared to public insurance. This study evaluates the difference in C-Section rates among nulliparous women in Florida hospitals across insurance groups and quantifies the contribution of maternal and hospital factors in explaining the difference in rates. Methods We used Florida’s inpatient data provided by the Florida Agency for HealthCare Administration (FLAHCA) and focused on low-risk births that occurred between January 1, 2010, and September 30, 2015. A Fairlie decomposition method was performed on cross-sectional data to decompose the difference in C-Section rates between insurance groups into the proportion explained versus unexplained by the differences in observable maternal and hospital factors. Results Of the 386,612 NTSV low-risk births, 72,984 were delivered via C-Section (18.87%). Higher prevalence of C-section at maternal level was associated with diabetes, hypertension, and the expectant mother being over 35 years old. Higher prevalence of C-section at the hospital level was associated with lower occupancy rate, presence of neonatal ICU (NICU) unit and higher obstetrics care level in the hospital. Private insurance coverage in expectant mothers is associated with C-section rates that were 4.4 percentage points higher as compared to that of public insurance. Just over 33.7% of the 4.4 percentage point difference in C-section rates between the two insurance groups can be accounted for by maternal and hospital factors. Conclusions The study identifies that the prevalence of C-sections in expectant mothers covered by private insurance is higher compared to mothers covered by public insurance. Although, majority of the difference in C-Section rates across insurance groups remains unexplained (around 66.3%), the main contributor that explains the other 33.7% is advancing maternal age and socioeconomic status of the expectant mother. Further investigation to explore additional factors that explain the difference needs to be done if United States wants to target specific policies to lower overall C-Section rate.

Audit of caesarean deliveries in ESUT Teaching Hospital (ESUTH) Enugu: A 3-year review

“…The prevalence of caesarean section in the public and private insured mothers in Florida by Puro N et al was estimated as 18.87% [19]. This was lower than that gotten from our study which was 29.6%.…”

“…This was lower than that gotten from our study which was 29.6%. The study revealed that higher rate of caesarean section was associated with diabetes, hypertension and expectant mothers being over 35 years [19]. However, the caesarean rate across the United States was approximately 32% [19].…”

Factors Contributing to Rapidly Increasing Rates of Caesarean Section in Andhra Pradesh, India: A Case-Control Study

“…Another study conducted in Egypt found similar rates of CS in government and private facilities, with rates of 35% and 36%, respectively. However, the study noted that there were differences in the characteristics of women who gave birth in government and private facilities, with women in private facilities being more likely to have higher education and higher income [ 20 ]. Overall, while the rates of CS may be similar in government and private health facilities, it is important to note that there may be differences in the reasons for performing CS and the characteristics of women who give birth in these facilities.…”

Maternal Serum Amyloid A as a Marker of Preterm Birth/PROM: A Systematic Review and Meta-Analysis

“…However, an important finding is the difference in delivery method between the study and control groups in Koseoglu et al’s study [ 25 ], as it suggests that the two groups may not have been entirely comparable. Cesarean section rates can be influenced by various factors, such as maternal age, gestational age, and underlying medical conditions, and these factors may also be related to the outcome of interest [ 30 ]. Therefore, it is possible that the difference in the delivery method may have contributed to any observed differences in the outcome between the study and control groups.…”