Factors Related to the High Cesarean Section Rate and Their Effects on the "Price Transparency Policy" in Beijing, China

Abstract

In urban China, many non-clinically indicated cesarean sections (NCSs) are performed, resulting in an unnaturally high cesarean section (CS) rate. NCSs represent CSs without any specific medical indications. The demand for NCS may be due to women's preference for CS and their belief in its safety and comfortableness. In addition, CS is more profitable for the supply side than vaginal delivery, which results in a continued rise in delivery expenditures. As a result, the so-called "price transparency policy", which forces hospitals to declare their average hospital charges, was adopted to control the delivery expenditures in the ongoing Chinese healthcare reform policy. The purpose of this study is to prove that the supply and demand factors affect the choice of delivery modes and more resources are consumed in NCS. The data of 680 live deliveries were collected from three hospitals in Beijing. Multinomial logistic regression analyses were conducted to identify the factors related to choosing NCS, and ANOVA and ANCOVA were used to compare the charges, proxy for resource utilization, among the delivery modes or hospitals. The results showed that the high NCS rate (37.7%) might be predicted not only based on the demand factors (region of residence, parity, maternal age and weight gain) but also on the supply factors (hospital dummy, revenue-staff ratio, bed turnover rate and obstetric medical staffs-delivery ratio), suggesting that such induced NCSs result in an unnecessarily high resource consumption. These data suggest that the present Chinese policy fails to control delivery expenditures.China; choice of delivery modes; hospital charge; non-clinically indicated caesarean section (NCS); price transparency policy

Practice audits to reduce caesareans in a tertiary referral hospital in south-western China

“…Unfortunately, this measure did not achieve its goal. 26 Professional bodies in China lack the power to ensure best practices; it is up to individual doctors and medical department heads to uphold medical and ethical principles in standard care. Furthermore, until WHO's global survey showed that China had the highest caesarean section rate in the South-East Asia Region, academic groups and professionals had focused primarily on preventing the complications of caesarean section rather than on preventing …”

Validation of the short form of the chinese childbirth self‐efficacy inventory in Mainland China

“…According to the National Health Services Survey (China Ministry of Statistics, 2004), among all pregnant women who delivered infants in mainland China, 20% in the rural areas and more than 63% in the urban areas were admitted to general hospitals. A strong technological influence has developed, and midwives are involved in task-oriented situations in general hospitals with little time is available for psychological and individualized support (Hong, 2007). The study was carried out in one general hospital, a leader in providing obstetric services in Guangzhou, where about 3,000 babies are delivered per year.…”

Factors influencing rising caesarean section rates in China between 1988 and 2008

“…1,[7][8][9] Between 1990 and 2002, the rate among primiparous women living in cities in China rose from 18% to 39% 8 and close to two thirds of urban women now give birth by caesarean section. [10][11][12] Although the rate in rural China has risen more slowly, it is now thought to be above 25%. 9,13,14 Opinions differ on why the rate has risen so rapidly in China.…”

“…On the demand side, women may request a caesarean section because they fear the consequences of vaginal delivery. 10,12,[15][16][17] When having one child is the norm, rich and well educated women may prefer birth by caesarean section to vaginal delivery because they think it is safer and free from pain and anxiety. 12,[15][16][17] More evidence for this reasoning comes from the high proportion of indications for caesarean section categorized as "woman's request" or "due to social factors" in hospital records 10,12,[15][16][17] and from the persistently higher rates observed among rich and well educated women.…”

“…10,12,[15][16][17] When having one child is the norm, rich and well educated women may prefer birth by caesarean section to vaginal delivery because they think it is safer and free from pain and anxiety. 12,[15][16][17] More evidence for this reasoning comes from the high proportion of indications for caesarean section categorized as "woman's request" or "due to social factors" in hospital records 10,12,[15][16][17] and from the persistently higher rates observed among rich and well educated women. 8,9,14,18 In contrast, others have emphasized health system factors, arguing that the rise in demand for caesarean section is largely stimulated by health-care providers and results from perverse financial incentives that encourage costly procedures.…”