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Cited by 43Maternal and Perinatal Health InterventionsHealthcare Policy and ManagementHealthcare Systems and Reforms

Increase in Caesarean Deliveries after the Australian Private Health Insurance Incentive Policy Reforms

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Einarsdóttir, Kristjana, Kemp, Anna, Haggar, Fatima A., Moorin, Rachael E., Gunnell, Anthony S., Preen, David B., Stanley, Fiona J., Holman, C. D’Arcy J·2012·PLoS ONE
DOI 10.1371/journal.pone.0041436PMC PMC3402394
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Abstract

BACKGROUND: The Australian Private Health Insurance Incentive (PHII) policy reforms implemented in 1997-2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA). METHODS AND FINDINGS: All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (-21.4 to -19.3) decrease in public birth rates, a 51% (45.1 to 56.4) increase in private birth rates, a 5% (-5.3 to -5.1) and 8% (-8.9 to -7.9) decrease in unassisted and assisted vaginal deliveries respectively, a 5% (-5.3 to -5.1) increase in caesarean sections with labour and 10% (8.0 to 11.7) increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0-3 days in hospital following birth decreased by 20% (-21.5 to -18.5), but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1). CONCLUSIONS: Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.

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  • The growth in cesarean rates cannot be explained by increases in obstetric risk factors, including delayed and multiple infant pregnancy and maternal obesity.

    “growth that cannot be explained by increases in obstetric risk factors, including those associated with delayed and multiple infant pregnancy and maternal obesity3–6”

    From The relation between cesarean birth and child cognitive development (2017) · cites this paper as [4]

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  1. [31]2005 Statistical Bulletin: NHS Maternity Statistics, England 2003 2004

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Authors
Einarsdóttir, K., Kemp, A., Haggar, F. A., Moorin, R. E., Gunnell, A. S., Preen, D. B., Stanley, F. J., & Holman, C. D. J.
Affiliations
  • The Kids Research Institute Australia (AU)
  • The University of Western Australia (AU)
  • Edith Cowan University (AU)
Corresponding author
Einarsdóttir, Kristjana
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2012-07-23
Volume
7
Issue
7
Pages
e41436
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0041436
PMC
PMC3402394
OpenAlex
W2023899669
Cited by
43
References
53
Citations by year
2024: 2 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 1 · 2017: 6 · 2016: 6 · 2015: 3 · 2014: 3 · 2013: 6 · 2012: 3
FWCI
5.79
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
  • Australasian Journal of Paramedicine (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eSpace (Curtin University) (submittedVersion, cc-by)
Funders
  • Department of Health, Government of Western Australia
  • Medical Research Council
  • National Health and Medical Research Council (634533, 573122)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
Keywords
private health insurance, cesarean section rate, mode of delivery, length of hospital stay, obstetric surgery, vaginal delivery, Australian health policy, Western Australia
MeSH terms
Adolescent, Adult, Australia, Birth Rate, Cesarean Section, Child, Female, Humans, Insurance, Health, Motivation, Pregnancy, Taxes, Health Care Reform, Young Adult

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