Significant differences in cesarean section rates between a private and a public hospital in Brazil

Junior, Almeida; Bettiol, Heloísa; Barbieri, Marco Antônio; Silva, Antônio Augusto Moura da; Ribeiro, Valdinar Sousa

doi:10.1590/s0102-311x2008001200020

Cited by 53 publications

(50 citation statements)

References 18 publications

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“…That is, the more "productive" the physicians are, the more revenue he/she generates, the higher bonuses he/she can get. Under such incentive and the predominant fee-for-service payment mechanism, physicians are more likely to take more "revenue generating" procedures, such as those that involve more medical technology for diagnosis and treatment, and prescribe more expensive medications, as the price of these procedures and prescriptions tend to provide higher margins [31,32] . Compared with vaginal delivery, Cesarean delivery has higher returns, not only because of the longer hospital stay associated with delivery by Caesarean section, but also because the antibiotics and other medicines involved in the procedure that also generate higher revenues to the hospitals.…”

Section: The Case Of Chinamentioning

confidence: 99%

“…Since the mid-1990s, 90% of the births are institutional, and 80% of the deliveries are financed by the Brazilian national health system, the Sistema Único de Saúde (SUS) [36] . Data for 2006 indicate that the overall rate of Cesarean sections in the SUS was 30.1% [37] , ranging from 18.9% [32] to 36% [36,38] , with some studies reporting rates as high as 43% throughout the years [39] .…”

Section: The Case Of Brazilmentioning

confidence: 99%

“…In the private sector, physicians perform CDs on times and days that are most suitable to them [36] . The majority of CDs are carried out during the weekday and routine working hours and, in the private sector, almost never on weekends or at odd hours [32] . While a doctor can perform a Cesarean section in an hour, a VD can extend for several hours, requiring doctors to work late or odd hours therefore making the former the method of choice by most physicians.…”

Section: The Case Of Brazilmentioning

confidence: 99%

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Factors associated with high Cesarean deliveries in China and Brazil - A Call for reducing elective surgeries in moving towards Universal Health Coverage

Hou¹,

Rakhshani

Iunes³

2014

JHA

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Background: Annually 6.2 million unnecessary Cesarean Deliveries (CD) are performed globally. Such high unnecessary CD rate is a concern not only due to the additional financial burden it places on the health system, but also because the quality of care could be compromised. There is an even more imperative need to reduce elective surgeries in moving towards the Universal Health Coverage (UHC), to ensure the ever stretched resources are effectively channeled for the best health outcomes. Methods:The paper uses a case study method. China and Brazil were selected primarily due to their alarmingly high number and percentage of the CD rate. Systematic literature review was conducted and the analyses were structured based on the framework "Determinants of High Cesarean Delivery Rates", developed by the authors. Results:In China and Brazil, cultural belief, fear of labor pain and patient's perception regarding quality of care may play a role in the patient's preference for CD but these perceptions are shaped by their health care providers as well. The principal-agent relation comes into play as the health professionals can modify perceived needs of their patients. Availability of health insurance to mothers, physicians' preference for convenient working hours, and payment incentives for performing higher yielding Cesarean procedures are driving the high CD rate phenomena in China and Brazil.Understand the social determinants of CD and using various instruments to change women's perceptions of birthing options and physicians' behaviors are critical in managing the CD rate. Conclusion:In the context of the rapid movement towards UHC, the evidence presented in this paper supports the call for implementing complementary policy interventions and regulation to ensure minimal efficiency loss due to resources being diverted to unnecessary procedures or hospital stays.

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Section: The Case Of Chinamentioning

confidence: 99%

Section: The Case Of Brazilmentioning

confidence: 99%

Section: The Case Of Brazilmentioning

confidence: 99%

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Factors associated with high Cesarean deliveries in China and Brazil - A Call for reducing elective surgeries in moving towards Universal Health Coverage

Hou¹,

Rakhshani

Iunes³

2014

JHA

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“…Studies 12,13,14,15 conducted in cities located in the Southeast region of Brazil of women who use private health insurance have found a prevalence of caesarean section ranging from 80% to 90%. The standard perinatal model of care for people who use private health insurance in Brazil has the following characteristics: antenatal care and delivery are provided by the same doctor, who is paid by private health insurers in a fee-for-service reimbursement system and who is responsible for covering antenatal care appointments during weekday office hours and for attending labour and birth 12 .…”

Section: Introductionmentioning

confidence: 99%

Cesariana e resultados neonatais em hospitais privados no Brasil: estudo comparativo de dois diferentes modelos de atenção perinatal

et al. 2014

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Objetiva-se comparar a prevalência de cesariana e desfechos neonatais de dois modelos de atenção ao parto em hospitais privados brasileiros, utilizando-se dados do estudo Nascer no Brasil, coorte de base hospitalar realizada nos anos 2011/2012. Foram analisadas 1.664 puérperas e seus conceptos, atendidos em 13 hospitais localizados na Região Sudeste, divididos em “típico” – modelo de atenção padrão, e “atípico” – Hospital Amigo da Criança com equipes de plantão e trabalho colaborativo entre enfermeiras obstétricas e médicos na atenção ao parto. A classificação de Robson foi adotada para a comparação das prevalências de cesariana, que foram menores no hospital atípico (47,8% vs. 90,8%, p < 0,001). Desfechos positivos relativos ao aleitamento materno foram mais frequentes no hospital atípico. Eventos neonatais adversos não apresentaram diferença significativa entre os hospitais. A intervenção adotada no hospital atípico deve ser avaliada em profundidade, uma vez que parece ter reduzido a prevalência de cesariana e aumentado as boas práticas de cuidado neonatal.

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“…Nesse mesmo contexto, uma maior chance de cesariana se mostrou associada aos melhores ní-veis de escolaridade 15 , partos em hospitais privados 23 , entre as mulheres de etnia branca 24 e entre aquelas que residem nas regiões geográficas socioeconomicamente mais desenvolvidas 18 , ou seja, entre as mulheres potencialmente de menor risco obstétrico.…”

Section: Introductionunclassified

Desigualdades sociais nas complicações da cesariana: uma análise hierarquizada

Freitas

Savi

2011

Cad. Saúde Pública

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Com objetivo de investigar associações entre fatores socioeconômicos e complicações da cesariana, uma amostra de 604 puérperas cujos partos ocorreram em duas maternidades no Sul do Brasil foi entrevistada 24 horas pós-parto e na segunda semana do puerpério, por meio de entrevistas hospitalares e domicilio. Regressão de Cox foi aplicada ao modelo hierárquico dos fatores associados ao tipo de parto e às complicações no pós-parto. Complicações foram duas vezes mais frequentes após cesariana, independentemente das condições socioeconômicas. Contudo, a maneira como o parto cesáreo se associou ao risco de complicações mostrou-se mediada pelas circunstâncias socioeconômicas representadas pela categoria do pré-natal e parto, ter ou não o mesmo profissional no pré-natal e parto e ter sua cesariana decidida intraparto. Resultados do estudo evidenciam que complicações pós-cirúrgicas da cesariana têm impacto adverso, principalmente, entre aquelas mulheres vivendo em condições sociais e de saúde menos privilegiadas, as quais, após o parto, retornam para um ambiente de menor suporte, com uma cicatriz abdominal.

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Significant differences in cesarean section rates between a private and a public hospital in Brazil

Abstract: This paper evaluates the association of maternal variables and of variables related to prena

Cited by 53 publications

References 18 publications

Factors associated with high Cesarean deliveries in China and Brazil - A Call for reducing elective surgeries in moving towards Universal Health Coverage

Factors associated with high Cesarean deliveries in China and Brazil - A Call for reducing elective surgeries in moving towards Universal Health Coverage

Cesariana e resultados neonatais em hospitais privados no Brasil: estudo comparativo de dois diferentes modelos de atenção perinatal

Desigualdades sociais nas complicações da cesariana: uma análise hierarquizada

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