Publicly insured caesarean sections in private hospitals: a repeated cross-sectional analysis in Chile

Abstract

Objective: To measure the likelihood of delivery by caesarean section (C-section) for publicly insured births as compared with privately insured births, across all hospitals and within private hospitals.

Design: Repeated cross-sectional analysis.

Setting: The universe of hospital births in 15 regions of Chile.

Participants: 2 405 082 singleton births between 2001 and 2014.

Outcome measures: C-section rates by type of hospital and type of insurance; contribution to overall C-section rates of subgroups by type of insurance and type of hospital; adjusted OR of privately insured births delivered by C-section compared with publicly insured births, across all hospitals and within private hospitals; percentage of discharges related to maternal morbidity and mortality across groups; length of stay after delivery.

Results: An increasing percentage of publicly insured births occur in private facilities each year. Approximately three out of four publicly insured births in private hospitals are delivered by C-section. The adjusted odd of C-section delivery in a private maternity unit is lower for those privately insured than for those with public insurance: OR 0.6, 95% CI 0.56 to 0.64. There is no evidence that these women would have been more likely to have a C-section out of medical necessity.

Conclusions: We find an association between high C-section rates and publicly insured women delivering at private institutions in Chile, and show that this group is driving the overall high and growing rates. There is a need for a more informed surveillance on the part of the public insurance system of its private providers' C-section practices.

Keywords: C-section; caesarean section; health care providers; insurance.