Dept. of Health Policy, London School of Economics, London, UK.
International Institute for Population Sciences, Mumbai, India.
Soc Sci Med. 2020 Nov;265:113511. doi: 10.1016/j.socscimed.2020.113511. Epub 2020 Nov 11.
Caesarean section (C-section) rates of over 15% suggest overuse of the surgery which may be difficult to justify on medical grounds. One important contributor to the rise in Csection rates is the rapid expansion of unregulated private-sector providers in number of settings. This study analyses the contribution of private sector in the rapid rise in Csection deliveries in India and the extent to which these can be justified on medical grounds.
This is a cross sectional study design using National Family Health Surveys. Logistic regression and propensity score matching (PSM) analyses are performed. The main outcome measured is avoidable C-sections in the private sector.
Our findings suggest that the rising trend in C-section rates in the private sector cannot be explained by medical reasons alone. The odds of C-section among women who chose to deliver in private was over 4 times higher than women who chose to delivery in public facilities. Despite, controlling for medical complications, women's characteristics and preferences, our PSM analysis suggest that the public-private gap has doubled over the years and that the difference cannot be explained by known determinants of C-section. Over supply of avoidable C-section to the extent of 21%, as a result of physician induced demand and perverse financial incentives was observed in the private sector.
This paper attempts to understand the reason for the high C-section rates in the private sector in India and the extent to which these are avoidable. Our analysis supports the assumption that physician induced demand as a result of perverse financial incentives in the private sector is at play.
剖宫产率超过 15%表明手术过度使用，这在医学上可能难以证明是合理的。剖宫产率上升的一个重要原因是不受监管的私营部门提供者在数量上的快速扩张。本研究分析了私营部门在印度剖宫产率快速上升中的作用，以及这些上升在多大程度上可以从医学角度证明是合理的。
这是一项使用国家家庭健康调查的横断面研究设计。进行了逻辑回归和倾向评分匹配（PSM）分析。主要测量的结果是私营部门中可避免的剖宫产术。
我们的研究结果表明，私营部门剖宫产率上升的趋势不能仅用医学原因来解释。选择在私营部门分娩的女性进行剖宫产的几率是选择在公共设施分娩的女性的 4 倍以上。尽管控制了医疗并发症、妇女的特征和偏好，但我们的 PSM 分析表明，多年来公私差距已经翻了一番，而且这种差异不能用剖宫产的已知决定因素来解释。在私营部门观察到，由于医生诱导需求和不良财务激励，可避免的剖宫产术供应过剩了 21%。
本文试图了解印度私营部门剖宫产率高的原因，以及这些剖宫产术在多大程度上是可避免的。我们的分析支持了这样一种假设，即由于私营部门的不良财务激励导致的医生诱导需求在起作用。
