Indiana University, Department of Public Health, School of Medicine, 410 W. 10th St. HITS 3115, Indianapolis, IN 46202, USA.
Health Policy. 2011 Feb;99(2):124-30. doi: 10.1016/j.healthpol.2010.07.016. Epub 2010 Aug 17.
To test the hypothesis that the health reform enacted in Peru in 1997 increased the rate of cesarean sections in the private sector due to non-clinical factors.
Different rounds of the Demographic and Health Survey are used to estimate determinants of c-section rates in private and public facilities before and after the healthcare reform. Estimations are based on a pooled linear regression controlling by obstetric and socioeconomic characteristics.
C-section rates in the private sector grew from 28 to 53% after the health reform. Compared to the Ministry of Health (MOH), giving birth in a private hospital in the post-reform period adds 19% to the probability of c-section.
The health reform implemented in the private sector increased physician incentives to over-utilize c-sections. The reform consolidated and raised the market power of private health insurers, but at the same time did not provide mechanisms to enlarge, regulate and disclose information of private providers. All these factors created the conditions for fee-for-service paid providers to perform more c-sections. Comparable trends in c-section rates have been observed in Latin American countries who implemented similar reforms in their private sector, suggesting a need to rethink the role of private health providers in developing countries.
检验 1997 年秘鲁实施的医疗改革是否因非临床因素导致私营部门剖宫产率上升的假设。
利用不同轮次的人口与健康调查，在医疗改革前后，估计私营和公共医疗机构剖宫产率的决定因素。估计结果基于控制产科和社会经济特征的汇总线性回归。
医疗改革后，私营部门的剖宫产率从 28%上升到 53%。与卫生部相比，在改革后时期在私立医院分娩会增加 19%的剖宫产概率。
在私营部门实施的医疗改革增加了医生过度使用剖宫产的激励。改革巩固并提高了私营医疗保险公司的市场权力，但同时没有提供扩大、监管和披露私营提供者信息的机制。所有这些因素为按服务收费的提供者进行更多的剖宫产创造了条件。在拉丁美洲国家实施类似的私营部门改革后，也观察到了类似的剖宫产率趋势，这表明需要重新思考私营医疗提供者在发展中国家的作用。
