Evaluation of Hospital Cesarean Delivery–Related Profits and Rates in the United States

Sakai‐Bizmark, Rie; Ross, Michael G.; Estevez, Dennys; Bedel, Lauren E. M.; Marr, Emily H.; Tsugawa, Yusuke

doi:10.1001/jamanetworkopen.2021.2235

Cited by 19 publications

(21 citation statements)

References 47 publications

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“…The likelihood of CS was higher in communities with high preponderance of private health facilities. This evidence corroborates the association found in past studies [ 36 , 71 ]. Public health facilities in Haiti are poorly financed, staffed and equipped [ 72 , 73 ].…”

Section: Discussionsupporting

confidence: 93%

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016–2017 Haitian Demographic and Health Survey

Simon¹,

Jean-Baptiste

Nazaire

et al. 2023

Trop Med Health

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Introduction For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10–15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti. Methods Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016–2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population’ characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05. Results The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8–6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00–1.96); who attended secondary (aOR = 1.95; 95% CI 1.39–2.76) and higher education level (aOR = 3.25; 95% CI 1.92–5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57–4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18–7.85) or 3–4 children (aOR = 2.07; 95% CI 1.09–3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40–3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25–2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48–0.91) were less likely to be delivered through CS than their counterparts with high birth weight. Conclusions While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women’s health in Haiti should take these disparities into account.

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Section: Discussionsupporting

confidence: 93%

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016–2017 Haitian Demographic and Health Survey

Simon¹,

Jean-Baptiste

Nazaire

et al. 2023

Trop Med Health

View full text Add to dashboard Cite

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“…Changing provider behavior and improving diagnostic skills could reduce C-section rates by up to 11.7% among the low-risk births [ 32 ]. Finally, one hospital-level factor that was not captured in our study was hospital profits per C-section procedure, since hospital profitability has been associated with higher odds of delivering newborns through C-section births [ 33 ]. The inclusion of some or all these factors would increase the explained variance if these factors were more prevalent in women covered by private insurance.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…35 Additional barriers to shared decision-making about birth settings include health care provider biases about birth center and home birth, [36][37][38] media bias and lack of knowledge about such options among the public, 39,40 and financial profits linked to patient numbers and cesarean birth. 41…”

Section: Shared Decision-making In Birth Settingsmentioning

confidence: 99%

Choosing a Birth Setting: A Shared Decision‐Making Approach

George

Mitchell²,

Stacey

2022

J Midwife Womens Health

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Perinatal outcomes vary widely depending on individual birth settings (birth center, home, and hospital). The purpose of this case study is to explore a patient-centered, shared decision-making approach to achieve an informed, values-based choice about birth settings. Engaging in a shared decision-making approach regarding birth setting options would support people to have the information and ability to judge for themselves how benefits and risks across birth center, home, and hospital settings would best fit with their values and personal health. A patient decision aid about birth setting options could facilitate increased equity regarding access to birth settings that offer improved perinatal health outcomes, helping to reduce perinatal health disparities in the United States.

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Evaluation of Hospital Cesarean Delivery–Related Profits and Rates in the United States

Cited by 19 publications

References 47 publications

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016–2017 Haitian Demographic and Health Survey

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016–2017 Haitian Demographic and Health Survey

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

Choosing a Birth Setting: A Shared Decision‐Making Approach

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