The promotion of private health insurance and its implications for the social organisation of healthcare: a case study of private sector obstetric practice in Chile

Abstract

This paper examines some of the implications of the process of privatisation of a national healthcare system for the delivery, organisation and, ultimately, the outcome of services. Through a case study of obstetric care in Chile, we illuminate the relationships between the macro-level of political decisions, the meso-level of the organisations through which government reforms were enacted, and the micro-level of clinical practice. We show that, for a significant proportion of Chilean women seeking maternity care, privatisation has led to expanded access and to ostensibly highly-personalised relationships with specialists. However, because of the fragmentation of maternity services, the altered work patterns for obstetricians occasioned by changes in healthcare financing and the relatively weak market position of most obstetricians, this personalised care is dependent on highly technologised obstetric practices. By examining the specific organisational arrangements under which private maternity care is conducted in Chile we shed light on the connection between privately-funded maternity care and high caesarean section rates in this setting.

What is hindering progress? The marginalization of women's sexual and reproductive health and rights in Brazil and Chile

“…a stable public sector job coupled with private sector responsibilities and revenue. In an analysis of Chilean obstetricians, Murray and Elston (2005) found that dual practice was common but that obstetricians then meted out different treatment to patients depending on the patient's social status and location.…”

Cognitive factors related to childbirth and their effect on women’s delivery preference: a comparison between a private and public hospital in Tehran

“…CSs are associated with an intrinsic risk of increased severe maternal outcomes compared with vaginal delivery [4][5][6]. Maternal demographic factors such as age, race, education, marital status, race/ ethnicity and other non-clinical factors like insurance status and institutional factors have been associated with and may increase the caesarean delivery rate [7][8][9][10][11][12][13][14][15].…”

“…Rates of CS vary according to hospital type; private hospitals have higher CS rates than do public one in both in both developed and developing countries [14][15][16]. Researchers have demonstrated the role of institutional factors such as ownership (private or public) [17,18].…”

“…Most previous studies of CS have focused on the association between rates and institutional type, size, private insurance [15] and physician factors [31] and there have been few studies that examined cognitive factors associated with preference for CS. Therefore, the primary aim of this study was to compare the differences in cognitive-related variables for CS (fear of pain, pain catastrophizing, attitude to childbirth) in private and public hospitals in Tehran, Islamic Republic of Iran.…”

Organizational elements of health service related to a reduction in maternal mortality: The cases of Chile and Colombia

“…Colombia continued to emphasize increasing coverage through the social security strategy of SGSSS [6], while Chile had already reached universal coverage and focused on improving equity [23,24] and resolutive capacity of essential obstetric services.…”