The Effectiveness of Financial Intervention Strategies for Reducing Caesarean Section Rates: a Systematic Review

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2019 Aug 11

PMID 31399068

Citations 7

Authors

Yushan Yu

Feili Lin

Weizhen Dong

Haohan Li

Xiangyang Zhang

Chun Chen

Affiliations

Soon will be listed here.

Abstract

Background: The increasing trend of Caesarean section (CS) in childbirth has become a global public health challenge. Previous studies have proposed financial intervention strategies for reducing CS rates by limiting caesarean delivery on maternal request (CDMR). This study synthesizes such strategies while evaluating their effectiveness.

Methods: The sources of data for this study are Cochrane Library, PubMed, EMBASE, and CINAHL. The publication period included in this study is from January 1991 to November 2018. The financial intervention strategies are divide into two categories: healthcare provider interventions and patient interventions. Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) was employed to assess the risk of bias of included studies. The outcome of each study was evaluated with Grades of Recommendation, Assessment, Development and Evaluation (GRADE) through the GRADEpro Guideline Development Tool software.

Results: Nine studies were included in this systematic review: five with high certainty evidence (HCE), three with moderate certainty evidence (MCE), and one with low certainty evidence (LCE). Of the nine studies, seven are centered on the effect of provider-side interventions. Three of the HCE studies found that the diagnosis-related group payment system, risk-adjusted capitation, and equalizing fee for both facilities and physicians were effective intervention strategies. One HCE and one MCE study showed that only equalizing facility fees between vaginal and CS deliveries in healthcare service settings had no significant effect on reducing the CS rate. The MCE study showed that case payment had a negative effect on reducing the CS rates. One LCE study revealed that the effect of a global budget system was uncertain, and one HCE and one MCE study focused on combining both provider and patient-side interventions. However, equalizing fees for vaginal and CS deliveries and a co-payment policy for CDMRs failed to reduce the CS rate.

Conclusions: The effectiveness of risk-adjusted payment methods appears promising and should be the subject of further research. Financial interventions should consider stakeholders' characteristics, especially the personal interests of doctors. Finally, high-quality randomized control trials and comparative studies on different financial intervention methods are needed to confirm or refute previous studies' outcomes.

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References

Brown 3rd H . Physician demand for leisure: implications for cesarean section rates. J Health Econ. 1996; 15(2):233-42. DOI: 10.1016/0167-6296(95)00039-9. View

Keeler E, Fok T . Equalizing physician fees had little effect on cesarean rates. Med Care Res Rev. 1996; 53(4):465-71. DOI: 10.1177/107755879605300405. View

Vimercati A, Greco P, Kardashi A, Rossi C, Loizzi V, Scioscia M . Choice of cesarean section and perception of legal pressure. J Perinat Med. 2000; 28(2):111-7. DOI: 10.1515/JPM.2000.014. View

Antioch K, Walsh M . Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding. Eur J Health Econ. 2004; 3(2):83-93. DOI: 10.1007/s10198-002-0096-7. View

Ndiaye S, Hopkins D, Shefer A, Hinman A, Briss P, Rodewald L . Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. Am J Prev Med. 2005; 28(5 Suppl):248-79. DOI: 10.1016/j.amepre.2005.02.016. View

Misra A . Impact of the HealthChoice program on cesarean section and vaginal birth after C-section deliveries: a retrospective analysis. Matern Child Health J. 2007; 12(2):266-74. DOI: 10.1007/s10995-007-0234-z. View

Lo J . Financial incentives do not always work: an example of cesarean sections in Taiwan. Health Policy. 2008; 88(1):121-9. DOI: 10.1016/j.healthpol.2008.02.013. View

Mougeot M, Naegelen F . Supply-side risk adjustment and outlier payment policy. J Health Econ. 2008; 27(5):1196-200. DOI: 10.1016/j.jhealeco.2008.05.007. View

Grant D . Physician financial incentives and cesarean delivery: new conclusions from the healthcare cost and utilization project. J Health Econ. 2008; 28(1):244-50. DOI: 10.1016/j.jhealeco.2008.09.005. View

10.

Volpp K, Loewenstein G, Troxel A, Doshi J, Price M, Laskin M . A test of financial incentives to improve warfarin adherence. BMC Health Serv Res. 2008; 8:272. PMC: 2635367. DOI: 10.1186/1472-6963-8-272. View

11.

Peabody J, Shimkhada R, Quimbo S, Florentino J, Bacate M, McCulloch C . Financial incentives and measurement improved physicians' quality of care in the Philippines. Health Aff (Millwood). 2011; 30(4):773-81. DOI: 10.1377/hlthaff.2009.0782. View

12.

Khunpradit S, Tavender E, Lumbiganon P, Laopaiboon M, Wasiak J, Gruen R . Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev. 2011; (6):CD005528. DOI: 10.1002/14651858.CD005528.pub2. View

13.

Handelzalts J, Fisher S, Lurie S, Shalev A, Golan A, Sadan O . Personality, fear of childbirth and cesarean delivery on demand. Acta Obstet Gynecol Scand. 2011; 91(1):16-21. DOI: 10.1111/j.1600-0412.2011.01287.x. View

14.

Grytten J, Monkerud L, Hagen T, Sorensen R, Eskild A, Skau I . The impact of hospital revenue on the increase in Caesarean sections in Norway. A panel data analysis of hospitals 1976-2005. BMC Health Serv Res. 2011; 11:267. PMC: 3210106. DOI: 10.1186/1472-6963-11-267. View

15.

Hong Y, Linn G . Financial incentives and use of Cesarean delivery: Taiwan birth data 2003 to 2007. Am J Manag Care. 2012; 18(1):e35-41. View

16.

Liu C, Lin Y, Su Y, Chang S, Cheng P . Impact of health policy based on the self-management program on Cesarean section rate at a tertiary hospital in Taiwan. J Formos Med Assoc. 2013; 112(2):93-8. DOI: 10.1016/j.jfma.2011.12.005. View

17.

Kozhimannil K, Law M, Virnig B . Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues. Health Aff (Millwood). 2013; 32(3):527-35. PMC: 3615450. DOI: 10.1377/hlthaff.2012.1030. View

18.

Quentin W, Scheller-Kreinsen D, Blumel M, Geissler A, Busse R . Hospital payment based on diagnosis-related groups differs in Europe and holds lessons for the United States. Health Aff (Millwood). 2013; 32(4):713-23. DOI: 10.1377/hlthaff.2012.0876. View

19.

Chen C, Liu T, Chen B, Lin C . The failure of financial incentive? The seemingly inexorable rise of cesarean section. Soc Sci Med. 2014; 101:47-51. DOI: 10.1016/j.socscimed.2013.11.010. View

20.

Yip W, Powell-Jackson T, Chen W, Hu M, Fe E, Hu M . Capitation combined with pay-for-performance improves antibiotic prescribing practices in rural China. Health Aff (Millwood). 2014; 33(3):502-10. DOI: 10.1377/hlthaff.2013.0702. View