Gonzalez-Perez G J, Vega-Lopez M G, Cabrera-Pivaral C, Muñoz A, Valle A
Centre for Health, Population and Human Development Studies, University of Guadalajara, Mexico.
Health Policy Plan. 2001 Mar;16(1):62-7. doi: 10.1093/heapol/16.1.62.
This paper seeks to quantify the magnitude of caesarean sections in Mexican public health-care institutions in recent years, to characterize the evolution of caesarean section rates (CSR) during the last decade, and to estimate the possible economic cost caused by the excess of caesareans performed in these institutions. The study is based on data obtained from the health sector, both for Mexico in the 5-year period 1993-97 and for the Mexican State of Jalisco between 1983 and 1998. Linear regression analysis was used to evaluate time series, and "excess of caesareans" was considered the number of caesarean deliveries performed above the admissible 15% CSR. The results reflect that on the national level, more than one-quarter of the deliveries handled by public institutions ended in caesarean section for each analyzed year, and if the deliveries performed in private institutions are included, the national rate is around 30%. A marked increase in CSR can be observed in Jalisco between 1983 and 1998 (almost 50%); and the cost for the nation of this CSR excess in financial terms is highly significant: several millions of dollars--obtained from public funds--are spent annually and unnecessarily by health services. The findings suggest that the increase in CSR is a public health problem that has not been satisfactorily faced by the health sector authorities. Many unnecessary caesareans would undoubtedly be avoided if the policies of these public health-care institutions were to consider, as a priority, both the known higher risk implicit in a caesarean for the health of the mother and child, and the economic impact on the country and its health institutions of the excessive number of caesareans performed yearly.
本文旨在量化近年来墨西哥公共卫生保健机构中剖宫产手术的规模，描述过去十年剖宫产率（CSR）的演变情况，并估算这些机构中因剖宫产手术过量而可能造成的经济成本。该研究基于从卫生部门获取的数据，包括1993 - 1997年这五年期间的墨西哥全国数据以及1983年至1998年期间墨西哥哈利斯科州的数据。采用线性回归分析来评估时间序列，“剖宫产手术过量”被定义为超出可接受的15%剖宫产率的剖宫产分娩数量。结果显示，在国家层面上，公共机构处理的分娩中，每年有超过四分之一以剖宫产结束；若将私立机构的分娩计算在内，全国剖宫产率约为30%。1983年至1998年期间，哈利斯科州的剖宫产率显著上升（近50%）；从财务角度来看，全国因这种剖宫产率过高而产生的成本非常巨大：卫生服务部门每年不必要地花费数百万美元的公共资金。研究结果表明，剖宫产率的上升是一个公共卫生问题，而卫生部门当局尚未令人满意地应对这一问题。如果这些公共卫生保健机构的政策优先考虑剖宫产对母婴健康已知的更高风险，以及每年过量剖宫产对国家及其卫生机构的经济影响，无疑可以避免许多不必要的剖宫产手术。
