Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study

Abstract

Objectives To explore the circumstances and factors that explain the association between private health insurance cover and a high rate of caesarean sections in Chile. Design Qualitative analysis of audiotaped in-depth interviews with obstetricians and pregnant women; quantitative analysis of data from face to face semistructured interview survey conducted postnatally (with women who had given birth in the previous 24-72 hours), and of a review of medical notes at a public hospital, a university hospital, and a private clinic. Setting Santiago, Chile. Participants Qualitative arm: 22 obstetricians, 21 pregnant women; quantitative arm: 540 postnatal women. Main outcome measures Rates of caesarean section in different types of institutions; consultants' views on private practice; work patterns in private practice; women's reasons for choosing private care; women's preferences on method of delivery. Results Private health insurance cover requires the primary maternity care provider to be an obstetrician. In the postnatal survey, women with private obstetricians showed consistently higher rates of caesarean section (range 57-83%) than those cared for by midwives or doctors on duty in public or university hospitals (range 27-28%). Only a minority of women receiving private care reported that they had wanted this method of delivery (range 6-32%). With the diversification in the healthcare market, most obstetricians now have demanding peripatetic work schedules. Private maternity patients are a lucrative source of income. The obstetrician is committed to attend these private births in person, and the "programming" (or scheduling) of births is a common time management strategy. The rate of elective caesarean sections was 30-68% in women with private obstetricians and 12-14% in women not attended by private obstetricians. Conclusions Policies on healthcare financing can influence maternity care management and outcomes in unforeseen ways. The prevailing business ethos in health care encourages such pragmatism among those doctors who do not have a moral objection to non-medical caesarean section.

Cesarean Delivery: Background, Trends, and Epidemiology

“…Results from one national US survey of mothers found little interest in a future elective primary cesarean with just 6% of primiparous mothers interested in that option in the future. 9 Research from other countries with high cesarean rates, most notably Brazil 10 and Chile, 11 have found that, rather than the cesarean rate being driven by maternal demands, it is the interaction between mothers and their providers that leads to the decision to perform a cesarean without a clear medical indication. For example, in Potter's study in Brazil, 10 more than 80% of primiparous mothers in the study anticipated a vaginal birth 1 month before their due date, yet almost half of these mothers (66% in private hospitals) ended up with a cesarean.…”

Placenta Percreta Con Invasión Vesical: Reporte De 2 Casos

“…La incidencia tanto de placenta previa y acretapercreta está aumentando. Esto principalmente por el aumento de los partos por operación cesárea, lo que es preocupante en nuestro medio, ya que nuestro país exhibe uno de los más altos índices de cesárea del mundo (8).…”

“…Esta patología constituye un desafío a la obstetricia actual dada su frecuente asociación con cicatrices uterinas previas (7) y el importante incremento del parto por cesárea en los últimos años, especialmente en nuestro medio (8), esperándose por consiguiente un aumento en la frecuencia de presentación.…”

Gobierno Del Parto en El Hospital Padre Hurtado: Un Modelo Para Contener La Tasa De Cesárea Y Prevenir La Encefalopatía Hipóxico-Isquémica

“…Si bien existen diferencias geográficas en Latinoamérica, la situación de Chile es una de las más preocupantes, con una tasa global de cesáreas cercana al 40% (1). Esta tasa se ha reportado como una de las mas altas del mundo, y se distribuye del 39% al 83% en la práctica privada y del 20% al 28% en los hospitales públi-cos durante el año 2000 (2).…”