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Sep 5, 2017Article Details
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Main Article Content
The impact of the fee-for-service reimbursement system on the utilisation of health services: Part III. A comparison of caesarean section rates in white nulliparous women in the private and public sectors
Abstract
The caesarean section (CS) rate among white women aged 20 - 35 years and having their first baby was examined, comparing the private fee-for-service medical aid sector with Johannesburg Hospital. The chance of having a CS in the private sector was 50% greater than in the public sector (28,7% v. 19,5%). Twice as many CSs were done on weekdays as over weekends, and it is argued that only a quarter of these are accounted for by elective procedures (planned before labour begins). We also found that in the private sector the daily frequency of non-caesarean deliveries was 56% higher during the week than on Saturdays or Sundays. Considering non-caesarean deliveries separately, it is inferred that the rate of induction of such deliveries was 28,7% in the private sector compared with 2,8% in Johannesburg Hospital. The evidence strongly confirms the international experience that the CS rate in a given population is not objectively determined by medical factors and is strongly influenced by individual doctors' decisions. Moreover, fee-for-service reimbursement of doctors leads to increased intervention in delivery, in the form of more frequent induction" of labour and more CSs.
