Indian Institute of Public Health, Gandhinagar, Gujarat, India.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2017 Oct 17;12(10):e0185739. doi: 10.1371/journal.pone.0185739. eCollection 2017.
The Chiranjeevi Yojana (CY) is a Public-Private-Partnership between the state and private obstetricians in Gujarat, India, since 2007. The state pays for institutional births of the most vulnerable households (below-poverty-line and tribal) in private hospitals. An innovative remuneration package has been designed to disincentivise unnecessary cesareans. This study examines characteristics of private facilities which participated in the program.
We conducted a cross-sectional survey of all facilities which had conducted any births between June 2012 and April 2013 in three districts. We identified 111 private and 47 public facilities. Ninety of the 111 private facilities did caesarean sections in the last three months and were eligible to participate in the CY program. Of these, 40 (44%) participated in the CY program. We conducted descriptive and bivariate analyses followed by a Poisson regression model to estimate prevalence ratios of facility characteristics that predicted participation.
We found that facilities participating in the CY program had a significantly higher likelihood of being general facilities (PR 1.9, 95% CI 1.3-2.9), or conducting lower proportion of cesarean births (PR 2.1, 95% CI 1.2-3.5) or having obstetricians new in private practice (PR 1.9, 95% CI 1.2-3.1) or being less expensive (PR 1.8, 95% CI 1.1-3.0). But none of these factors retained significance in a multi variable model.
Private obstetricians who participate in the CY program tend to be new to private practice, provide general services, conduct fewer caesareans and are also less expensive. This is advantageous to the PPP and widens the target beneficiary groups that can be serviced by the PPP. The state should design remuneration packages with the aim of attracting relatively new obstetricians to set up practices in more remote areas. It is possible that the CY remuneration package design is effective in keeping caesarean rates in check, and needs to be studied further.
Chiranjeevi Yojana（CY）是印度古吉拉特邦自 2007 年以来实行的公私合作伙伴关系，由国家和私人产科医生共同参与。该计划由国家为最弱势群体（贫困线以下和部落）在私人医院的分娩提供费用。该计划设计了一个创新的薪酬方案，以抑制不必要的剖宫产。本研究旨在分析参与该计划的私立医疗机构的特征。
我们对 2012 年 6 月至 2013 年 4 月期间在三个地区进行过任何分娩的所有医疗机构进行了横断面调查。我们共识别出 111 家私立医院和 47 家公立医院。在这 111 家私立医院中，有 90 家在过去三个月进行了剖宫产手术，有资格参与 CY 计划。其中 40 家（44%）参与了 CY 计划。我们进行了描述性和双变量分析，然后进行泊松回归模型，以估计预测参与的医疗机构特征的患病率比。
我们发现，参与 CY 计划的医疗机构更有可能是综合性医疗机构（PR 1.9，95%CI 1.3-2.9），或剖宫产比例较低（PR 2.1，95%CI 1.2-3.5），或产科医生新开业（PR 1.9，95%CI 1.2-3.1），或价格较低（PR 1.8，95%CI 1.1-3.0）。但这些因素在多变量模型中均无统计学意义。
参与 CY 计划的私立产科医生往往是新开业的，提供综合服务，剖宫产率较低，而且价格较低。这对公私合作伙伴关系是有利的，并扩大了可以由公私合作伙伴关系服务的目标受益人群。国家应设计薪酬方案，旨在吸引相对较新的产科医生在较偏远地区开展业务。CY 薪酬方案的设计可能有效控制剖宫产率，需要进一步研究。
