title: 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.
authors.affiliation: Department of Community Health, University of the Witwatersrand, Johannesburg.
authors.forename: M R
authors.initials: MR
authors.lastname: Price
authors.forename: J
authors.initials: J
authors.lastname: Broomberg
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005251:Fees, Medical; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006777:Hospitals, Proprietary / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D010067:Ownership; D010298:Parity; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D013019:South Africa; D044465:White People