Department of Management Programs, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America.
Department of Health Administration and Policy, School of Health Sciences, University of New Haven, West Haven, CT, United States of America.
PLoS One. 2022 Apr 7;17(4):e0266666. doi: 10.1371/journal.pone.0266666. eCollection 2022.
Caesarean section (C-sections) is a medically critical and often life-saving procedure for prevention of childbirth complications. However, there are reports of its overuse, especially in women covered by private insurance as compared to public insurance. This study evaluates the difference in C-Section rates among nulliparous women in Florida hospitals across insurance groups and quantifies the contribution of maternal and hospital factors in explaining the difference in rates.
We used Florida's inpatient data provided by the Florida Agency for HealthCare Administration (FLAHCA) and focused on low-risk births that occurred between January 1, 2010, and September 30, 2015. A Fairlie decomposition method was performed on cross-sectional data to decompose the difference in C-Section rates between insurance groups into the proportion explained versus unexplained by the differences in observable maternal and hospital factors.
Of the 386,612 NTSV low-risk births, 72,984 were delivered via C-Section (18.87%). Higher prevalence of C-section at maternal level was associated with diabetes, hypertension, and the expectant mother being over 35 years old. Higher prevalence of C-section at the hospital level was associated with lower occupancy rate, presence of neonatal ICU (NICU) unit and higher obstetrics care level in the hospital. Private insurance coverage in expectant mothers is associated with C-section rates that were 4.4 percentage points higher as compared to that of public insurance. Just over 33.7% of the 4.4 percentage point difference in C-section rates between the two insurance groups can be accounted for by maternal and hospital factors.
The study identifies that the prevalence of C-sections in expectant mothers covered by private insurance is higher compared to mothers covered by public insurance. Although, majority of the difference in C-Section rates across insurance groups remains unexplained (around 66.3%), the main contributor that explains the other 33.7% is advancing maternal age and socioeconomic status of the expectant mother. Further investigation to explore additional factors that explain the difference needs to be done if United States wants to target specific policies to lower overall C-Section rate.
剖宫产（C -section）是一种医学上的重要手段，常用于预防分娩并发症，挽救生命。然而，有报道称其存在过度使用的情况，特别是在私人保险覆盖的女性中，比公共保险更为常见。本研究评估了佛罗里达州各医院中不同保险组别的初产妇剖宫产率差异，并量化了产妇和医院因素对解释这种差异的贡献。
我们使用了佛罗里达州卫生保健管理局（FLAHCA）提供的佛罗里达州住院数据，研究对象为 2010 年 1 月 1 日至 2015 年 9 月 30 日期间发生的低风险分娩。我们对横截面数据进行了 Fairlie 分解，将保险组间剖宫产率的差异分解为可观察到的产妇和医院因素差异解释的比例和无法解释的比例。
在 386612 例 NTSV 低风险分娩中，72984 例（18.87%）通过剖宫产分娩。产妇层面剖宫产率较高与糖尿病、高血压和产妇年龄超过 35 岁有关。医院层面剖宫产率较高与较低的床位占用率、新生儿重症监护病房（NICU）的存在和医院产科护理水平较高有关。产妇私人保险覆盖与公共保险相比，剖宫产率高出 4.4 个百分点。在这两个保险组间的 4.4 个百分点的剖宫产率差异中，只有略高于 33.7%可以归因于产妇和医院因素。
本研究发现，私人保险覆盖的产妇剖宫产率高于公共保险覆盖的产妇。尽管保险组间剖宫产率的差异大部分（约 66.3%）仍无法解释，但解释其余 33.7%差异的主要因素是产妇年龄的增长和社会经济地位的提高。如果美国希望制定针对特定政策以降低整体剖宫产率，那么需要进一步调查以探索其他解释差异的因素。
