Kolegji Heimerer, Pristina, Kosovo
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA.
BMJ Open. 2021 May 24;11(5):e044383. doi: 10.1136/bmjopen-2020-044383.
The objective of this study is to explore the association of health financing indicators with the proportion of births by caesarean section (CS) across countries.
Ecological cross-country study.
This study examines CS proportions across 172 countries.
The primary outcome was the percentage excess of CS proportion, defined as CS proportions above the global target of 19%. We also analysed continuous CS proportions, as well as excess proportion with a more restrictive 9% global target. Multivariable linear regressions were performed to test the association of health financing factors with the percentage excess proportions of CS. The health financing factors considered were total available health system resources (as percentage of gross domestic product), total contributions from private households (out-of-pocket, compulsory and voluntary health insurance contributions) and total national income.
We estimate that in 2018 there were a total of 8.8 million unnecessary CS globally, roughly two-thirds of which occurred in upper middle-income countries. Private health financing was positively associated with percentage excess CS proportion. In models adjusted for income and total health resources as well as human resources, each 10 per cent increase in out-of-pocket expenditure was associated with a 0.7 per cent increase in excess CS proportions. A 10 per cent increase in voluntary health insurance was associated with a 4 per cent increase in excess CS proportions.
We have found that health system finance features are associated with CS use across countries. Further monitoring of these indicators, within countries and between countries will be needed to understand the effect of financial arrangements in the provision of CS.
本研究旨在探讨卫生筹资指标与各国剖宫产率（CS）的关系。
生态跨国研究。
本研究考察了 172 个国家的 CS 比例。
主要结局是 CS 比例的超额百分比，定义为 CS 比例高于全球目标的 19%。我们还分析了连续的 CS 比例，以及更严格的 9%全球目标的超额比例。采用多元线性回归分析卫生筹资因素与 CS 超额比例的关系。考虑的卫生筹资因素包括：卫生系统总可用资源（占国内生产总值的百分比）、来自私人家庭的总捐款（自费、强制性和自愿健康保险缴款）以及国民总收入。
我们估计，2018 年全球共有 880 万例不必要的 CS，其中大约三分之二发生在上中等收入国家。私人卫生筹资与 CS 超额比例呈正相关。在调整收入、总卫生资源和人力资源的模型中，自费支出每增加 10%，CS 超额比例就会增加 0.7%。自愿健康保险增加 10%，CS 超额比例就会增加 4%。
我们发现卫生系统融资特征与各国 CS 的使用有关。需要在国家内部和国家之间进一步监测这些指标，以了解 CS 提供方面财务安排的影响。
