Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
PLoS One. 2012;7(7):e41436. doi: 10.1371/journal.pone.0041436. Epub 2012 Jul 23.
The Australian Private Health Insurance Incentive (PHII) policy reforms implemented in 1997-2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA).
All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (-21.4 to -19.3) decrease in public birth rates, a 51% (45.1 to 56.4) increase in private birth rates, a 5% (-5.3 to -5.1) and 8% (-8.9 to -7.9) decrease in unassisted and assisted vaginal deliveries respectively, a 5% (-5.3 to -5.1) increase in caesarean sections with labour and 10% (8.0 to 11.7) increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0-3 days in hospital following birth decreased by 20% (-21.5 to -18.5), but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1).
Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.
1997 年至 2000 年实施的澳大利亚私人医疗保险激励（PHII）政策改革使澳大利亚的 PHI 会员增加了 50%。鉴于私人保险患者的产科干预率较高，改革可能导致剖宫产分娩和住院时间延长的分娩增加。我们旨在调查 PHII 政策引入对西澳大利亚州（WA）出生特征的影响。
从 WA 卫生部持有的行政分娩和医院数据系统中确定了 1995 年 1 月至 2004 年 3 月期间的所有 230,276 例分娩入院病例。估计 PHII 引入后的平均季度出生率，并与没有发生改革的情况下的预期出生率进行比较。按分娩方式、分娩后住院时间长短，分别为公共和私人患者、剖宫产分娩和阴道分娩，估算率和百分比差异（包括 95%置信区间）。PHII 政策引入与公共分娩率降低 20%（-21.4 至-19.3）、私人分娩率增加 51%（45.1 至 56.4）、无辅助阴道分娩和辅助阴道分娩分别减少 5%（-5.3 至-5.1）和 8%（-8.9 至-7.9）、有产程的剖宫产分娩增加 5%（-5.3 至-5.1）和无产程的剖宫产分娩增加 10%（8.0 至 11.7）有关。同样，出生后在医院住院 0-3 天的婴儿出生率下降 20%（-21.5 至-18.5），但住院时间超过 3 天的出生人数增加了 15%（12.2 至 17.1）。
澳大利亚实施 PHII 政策后，私人保险患者的分娩、剖宫产分娩和婴儿住院时间延长的分娩增加。这些改革可能对澳大利亚的产科护理质量或澳大利亚医院的负担没有好处。
