Private health care coverage and increased risk of obstetric intervention

BMC Pregnancy and Childbirth

Richard A Greene²  Sarah Meaney²  Declan Devane¹  Michael Murphy²  Jennifer E Lutomski³ 

[1] School of Nursing and Midwifery, National University of Ireland, Galway, Ireland;National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland;Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre, Nijmegen, Netherlands

关键词: Pregnancy;    Episiotomy;    Induction of labour;    Obstetric forceps;    Vacuum extraction;    Caesarean section;   

Others  :  1131798
DOI  :  10.1186/1471-2393-14-13

 received in 2013-06-04, accepted in 2013-12-24,  发布年份 2014

【 摘 要 】

Background

When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria.

Methods

Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors.

Results

403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43).

Conclusions

Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.

【 授权许可】

   
2014 Lutomski et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Huesch MD: Association between type of health insurance and elective cesarean deliveries: New Jersey, 2004–2007. Am J Public Health 2011, 101(11):e1-e7. 2011/11/01
• [2]Misra A: Impact of the health choice program on cesarean section and vaginal birth after C-section deliveries: a retrospective analysis. Matern Child Health J 2008, 12(2):266-274.
• [3]Lipkind HSDC, Rosenberg TJ, Funai EF, Chavkin W, Chiasson MA: Disparities in cesarean delivery rates and associated adverse neonatal outcomes in New York City hospitals. Obstet Gynecol 2009, 113(6):1239-1247.
• [4]Roberts CL, Tracy S, Peat B: Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. BMJ 2000, 321(7254):137-141.
• [5]Dahlen HG, Tracy S, Tracy M, Bisits A, Brown C, Thornton C: Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open 2012., 2(5) doi: 10.1136/bmjopen-2012-001723
• [6]Cai WW MJ, Chen CH, Zhuang YX, Morris L, Harris JR: Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China. Am J Public Health 1998, 88(5):777-780. 1998 May
• [7]Mossialos EAS, Karras K, Davaki K: An investigation of Caesarean sections in three Greek hospitals: the impact of financial incentives and convenience. Eur J Public Health 2005, 15(3):288-295. Epub 2005 May 27
• [8]Di Lallo D, Perucci CA, Bertollini R, Mallone S: Cesarean section rates by type of maternity unit and level of obstetric care: an area-based study in central Italy. Prev Med 1996, 25(2):178-185.
• [9]Coulm B, Le Ray C, Lelong N, Drewniak N, Zeitlin J, Blondel B: Obstetric interventions for low-risk pregnant women in France: do maternity unit characteristics make a difference? Birth 2012, 39(3):183-191.
• [10]Barros AJD, Santos IS, Matijasevich A, et al.: Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off. Rev Saude Publica 2011, 45:635-643.
• [11]Murray SF: Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study. BMJ 2000, 321(7275):1501-1505.
• [12]Roberts CL, Algert CS, Carnegie M, Peat B: Operative delivery during labour: trends and predictive factors. Paediatr Perinat Epidemiol 2002, 16(2):115-123.
• [13]Kennedy P: Healthcare reform: maternity service provision in Ireland. Health Policy 2010, 97:145-151.
• [14]The economic and social research institute. Hospital in-patient enquiry scheme [online] Available: http://www.esri.ie/health_information/hipe/ webcite. Accessed 29 July 2012
• [15]Lutomski JE, Morrison JJ, Greene RA, Lydon-Rochelle MT: Maternal morbidity during hospitalization for delivery. Obstet Gynecol 2011, 117(3):596-602.
• [16]Bramley M, Reid BA: Morbidity data quality initiatives in Ireland. HIM J 2005, 34(2):47-53.
• [17]Bramley M, Reid BA: Clinical coder training initiatives in Ireland. HIM J 2005, 34(2):40-46.
• [18]The Economic and Social Research Institute: National perinatal reporting system perinatal statistics report. 2010. Available: http://www.esri.ie/health_information/nprs/nprs_reports/Perinatal_Statistics_Report_2010.pdf webcite. Accessed 2 September 2013
• [19]Jun Zhang M, Kai F, Yu P: What's the relative risk? JAMA 1998, 280(19):1690-1691. doi:10.1001/jama.280.19.1690
• [20]Mozurkewich E, Chilimigras J, Koepke E, Keeton K, King VJ: Indications for induction of labour: a best-evidence review. BJOG 2009, 116(5):626-636.
• [21]Anim-Somuah M, Smyth RM, Jones L: Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev 2011, 12:CD000331.
• [22]Wood S, Cooper S, Ross S: Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes. BJOG 2013. doi:10.1111/1471-0528.12328
• [23]Lutomski JE, Morrison JJ, Lydon-Rochelle MT: Regional variation in obstetrical intervention for hospital birth in the Republic of Ireland, 2005–2009. BMC Pregnancy Childbirth 2012., 12(123) doi:10.1186/1471-2393-1112-1123
• [24]Joseph KS, Dodds L, Allen AC, et al.: Socioeconomic status and receipt of obstetric services in Canada. Obstet Gynecol 2006, 107(3):641-650.
• [25]Movas TZ, Wells E, Mongoven A, Grigorescu V: Does medical insurance type (private vs public) influence the physician’s decision to perform Caesarean delivery? J Med Ethics 2012, 38:470-473.
• [26]Boutsikou T: Malamitsi-Puchner. Caesarean Sect 2011, 100(12):1518-1522.
• [27]Groom KM, Paterson-Brown S, Fisk NM: Temporal and geographical variation in UK obstetricians' personal preference regarding mode of delivery. Eur J Obstet Gynecol Reprod Biol 2002, 100(2):185-188.
• [28]Fuglenes D, Kristiansen IS: Obstetrician's choice of cesarean delivery in ambiguous cases: is it influenced by risk attitude or fear or complaints and litigation? Am J Obstet Gynecol 2009, 200:48. e41-48.e48
• [29]Brown HS: Lawsuit activity, defensive medicine, and small area variation: the case of cesarean sections revisited. Health Econ Policy Law 2007, 2(Pt 3):285-296.
• [30]Ryan K, Schnatz P, Greene J, Curry S: Change in cesarean section rate as a reflection of the present malpractice crisis. Conn Med 2005, 69(3):139-141.
• [31]Zwecker P, Azoulay L, Abenhaim HA: Effect of fear of litigation on obstetric care: a nationwide analysis on obstetric practice. Am J Perinatol 2011, 28(4):277-283.
• [32]Fuglenes D, Aas E, Botten G, Oian P, Kristiansen IS: Why do some pregnant women prefer cesarean? The influence of parity, delivery experiences, and fear. Am J Obstet Gynecol 2011, 205:45. e41-49
• [33]Mazzoni A, Althabe F, Liu N, et al.: Women’s preference for caesarean section: a systematic review and meta-analysis of observational studies. BJOG 2011, 118(4):391-399.
• [34]Grobman WA, Lai Y, Landon MB, et al.: The change in the rate of vaginal birth after caesarean section. Paediatr Perinat Epidemiol 2011, 25(1):37-43.
• [35]Pang MW, Law LW, Leung TY, Lai PY, La TK: Sociodemographic factors and pregnancy events associated with women who declined vaginal birth after cesarean section. Eur J Obstet Gynecol Reprod Biol 2008, 143(1):24-28.
• [36]Robson M: Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynaecol 2001, 15(1):179-194.
• [37]Goetzinger KR, Macones GA: Operative vaginal delivery: current trends in obstetrics. Womens Health (Lond Engl) 2008, 4(3):281-290.
• [38]O'Mahony F, Hofmeyr GJ, Menon V: Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev 2010, 11:CD005455. doi:10.1002/14651858.CD005455.pub2
• [39]Carroli G, Mignini L: Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009, 21(1):CD000081.
• [40]ACOG Practice Bulletin No. 71: Episiotomy. Obstet Gynecol 2006, 107(4):957-962.
• [41]National Institute for Health and Clinical Excellence: Intrapartum care. London: UK: NICE clinical guideline 55; 2007.
• [42]Frankman EA, Wang L, Bunker CH, Lowder JL: Episiotomy in the United States: has anything changed? Am J Obstet Gynecol 2009, 200:573. e571-573.e577
• [43]Roberts CL, Algert CS, Raynes-Greenow C, Peat B, Henderson-Smart DJ: Delivery of singleton preterm infants in New South Wales, 1990–1997. Aust N Z Obstet Gynaecol 2003, 43(1):32-37.
• [44]McLachlan H, Forster D, Davey M, et al.: Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG 2012, 119(12):1483-1492.
• [45]Yasmeen S, Romano PS, Schembri ME, Keyzer JM, Gilbert WM: Accuracy of obstetric diagnoses and procedures in hospital discharge data. Am J Obstet Gynecol 2006, 194(4):992-1001.
• [46]Hadfield RM, Lain SJ, Cameron CA, Bell JC, Morris JM, Roberts CL: The prevalence of maternal medical conditions during pregnancy and a validation of their reporting in hospital discharge data. Aust N Z J Obstet Gynaecol 2008, 48:78-82.
• [47]Kuklina EV, Whiteman MK, Hillis SD, et al.: An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008, 12(4):469-477.
• [48]Lutomski JE, Greene RA, Byrne BM: Severe maternal morbidity during childbirth hospitalisation: a comparative analysis between the Republic of Ireland and Australia. Eur J Obstet Gynecol Reprod Biol 2012, 163(2):148-153.
• [49]The Economic and Social Research Institute: Activity in acute public hospitals in Ireland. 2010. Annual Report Available: http://www.esri.ie/health_information/latest_hipe_nprs_reports/2010_hipe_report/index.xml webcite. Accessed 2 September 2013
• [50]Khunpradit S, Tavender E, Lumbiganon P, Laopaiboon M, Wasiak J, Gruen RL: Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev 2011, 15(6):CD005528.