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Whooping 9 Lakh “Preventable” C-section births in Indian PVT hospitals, mainly for financial incentives: IIM-A study

Whooping 9 Lakh “Preventable” C-section births in Indian PVT hospitals, mainly for financial incentives: IIM-A study

Ahmedabad: There were as many as nine lakh “preventable” unplanned Caesarean section (C-section) deliveries out of 70 lakh in private hospitals in India in one year, driven mainly by “financial incentives,” says a study by Indian Institute of Management-Ahmedabad.

Such “medically unjustified” births not just cause “large out-of-pocket expenses” but also “delayed breastfeeding, lower birth-weight, respiratory morbidities” among other troubles for the newborn, it says.

The study is titled “Too much care? Private health care sector and surgical interventions during childbirth in India,” and was carried out by IIM-A faculty member Ambrish Dongre and doctoral student Mitul Surana.

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The study finds “a woman opting for the private facility is 13.5-14 percentage points more likely to undergo an unplanned C-section (compared to public facilities)”.

The figure is based on the fourth round of the National Family Health Survey (NFHS), carried out in 2015-16, which found that 40.9 per cent births in private facilities in India were through C-section as against 11.9 per cent in public facilities.

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The study observes that “supplier-induced demand” for unplanned C-section births in private facilities is mainly driven by “financial incentives.”

“Even though private providers might be more responsive to patients and exert more effort, they are also more likely to provide over-intensive treatments either as a response to demand from patients or due to financial incentives,” it says.

Quoting NFHS, the IIMA study says that a natural birth in private facility costs, on an average, Rs 10,814, while a C-section costs Rs 23,978.

“The supplier-induced demand driven by financial incentives especially when the patient has limited information is probably an important explanation” for the higher rate of C- section birth in private facilities, it further says.

“When medically justified, C-sections prevent maternal and perinatal mortality and morbidity. But if performed when not needed, they impose a huge burden on the mother and the child that go beyond large out-of-pocket expenses,” the study states.

“For the newborn, it means delayed breastfeeding, lower birth weight, respiratory morbidities, increased rate of hospitalisation, lower Apgar scores and its implication in the long run,” it says.

The study seeks “to evaluate whether the private sector can be an effective partner in providing health services,” especially in the light of the National Health Policy 2017, which provides coverage of Rs 5 lakh for poor households to seek secondary and tertiary health care in public or empanelled private hospitals.

In order to bring down the number of “C-sections that are not needed,” the government will have to strengthen “public sector facilities, not just in terms of equipment and staffing, but also in terms of facility timings, absenteeism and attitudes of service providers,” it concludes.

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Source: PTI

5 comment(s) on Whooping 9 Lakh “Preventable” C-section births in Indian PVT hospitals, mainly for financial incentives: IIM-A study

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  1. This is the kind of pseudo scientific study done by a non medical person who decide what is right and what is wrong without a clue of on the ground realities face by gynecologist
    On demand section
    Absolute no to any trial of labour on non vertex presentation
    A careful monitoring which picks fetal distress naturally bump up c/s rates
    Most hospitals pay the same be it normal or section deliveries these days so the financial incentive is rubbish

    This kind of study give credence to the old saying
    Give a dog a bad name and hang it

  2. user
    Dr Ashutosh Kumar Jha December 4, 2018, 10:43 am

    Dear all
    I think the investigators have overlooked many contributing and confounding factors worth consideration as below–
    1.While considering proportion of cs deliveries, you must take into account the no of ANC cases under a gynecologist. Most of them first try out home delivery, then PHCs, then govt hospitals which are not only free , rather provide financial incentives also, Only the cases thus filtered out who fail to deliver vaginally , go / sent to private hospitals, That is the main cause of higher CS rates at private.
    2.Fear due to increasing legal & physical attacks may be a major cause.
    3.Regarding the financial lusts, just see the cost difference between vaginal and CS deliveries. A huge portion of it will go to the Anaesthesiologist, assistants , drugs and other expenses.So this logic is hardly palatable.
    4. If you will see the time trends, most of the district govt hospitals hardly have round the clock CS facilities and these cases flee to the private.
    Thus we have to analyse all the aspects for an unbiased conclusion.

  3. What methodology have \”management\” students applied? Of course, pvt hospitals will play safe and take an early decision of c section. Cos if they do not, then they ll have a negligence case slapped on them! Besides, govt hospitals always have a shortage of operation theatres, staff to do as many surgeries as indicated and they end up doing c sections for those who require it the most. Pvt hospitals have ready teams and ots so make the decision at the earliest indication. And not to forget all risks and benefits are explained to patient before consent.

  4. the management teams should focus on management and not on medical events.
    They will next probably come up with a \”cost of each life\” and determine that most lives are costly and should be terminated.
    Money must be saved even at the cost of lives or morbidity.

  5. It will be interesting to know how these management students come to these conclusions. Retrospectively it\’s easy to say C section was not needed.

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