The Council for Medical Schemes (CMS) said urgent steps must be taken to reduce high levels of medically unnecessary caesarean births in the medical schemes population, following an analysis based on 105 485 birth admissions from all schemes that submitted data for the 2018 Healthcare Utilisation Annual Statutory Returns.
The council says in a research brief that the overall caesarean section (CS) rate for the medical schemes industry was 77.4%, which is among the highest in the world. According to a CMS analysis the rate of caesarean births, most of which are likely to be elective, has remained high in the population covered by medical schemes, even though they are not a chronic condition benefit.
“The high levels of CS cannot be explained by clinical profiles of pregnant women covered by medical schemes. Healthcare provider influence, funder accountability and beneficiary choices for a birth procedure have serious financial implications for the National Health Insurance and the health outcomes of both the child and mother. Urgent steps must be taken to reduce high levels of medically unnecessary CS rates in the medical schemes population.
“It is estimated nearly 15% of pregnant women will experience obstetric complications during their pregnancy, and CS delivery will be a life-saving intervention for between 3.6% and 6.5% of cases.
“The fear of litigation has been implicated as one of the factors associated with the increased rates of CS births. Possibility of reforms in the medical malpractice regime must be investigated. Alternative mechanisms to finance maternity care in the population covered by medical schemes to drive appropriate incentives must be investigated. A high reimbursement rate for CS deliveries is a likely driver for the very high prevalence of CS in the medical schemes population,” said the report.
The total of 105 485 birth admissions from all schemes that submitted data for the 2018 Healthcare Utilisation Annual Statutory Returns were included in the analysis. Births admissions were reported in the ages ranging from 10 to 54 years among a total of 3 273 285 female beneficiaries.
“A CS can be a life-saving procedure when certain conditions such as life-threatening maternal or perinatal complications are present. On the other hand, elective CS predisposes women to avoidable risks of infection, surgical and anaesthetic complications, reduced likelihood of breastfeeding, and risks for the baby.
“The rising rates of CS in the private sectors has been a concern during the past few years. The World Health Organisation estimates that CS is any region of the world should not be greater than higher than 10 to 15 % in clinically indicated cases. It is estimated that nearly 15% of pregnant women will experience obstetric complications during their pregnancy and CS delivery will be a lifesaving intervention for between 3.6% and 6.5% of cases. The current rate of CS deliveries of 76.9% in the population covered by medical is among the highest in the world.
“The analysis showed an annualised increase of 0.6% for CS, a trend which is expected to continue in the absence of appropriate interventions. The national rate of CS delivery in the South African public sector was 26.2% in the 2015/2016 financial year. The sub-Saharan region has one of the lowest rates of CS in the world, partly because of poor access to obstetric care. According the Organization for Economic Co-operation and Development (OECD) data, among European countries Italy, Poland, and Hungary have the highest CS rate (35.7%), whereas Scandinavian nations have the lowest (Finland 15.8%; Norway 16.6%; and Sweden 17.0%).
“The cost of CS births is high compared to normal vaginal deliveries (NVD). The burden is also high for the private healthcare system, considering the annual above inflation increases in contribution. Substantial reductions in the rates of caesarean birth will go a long way in reducing the cost of maternal health and the health system in general. The high reimbursement rates for CS compared to the NVD is likely to be a contributing factor to the high levels CS deliveries. Our study showed that the average cost of CS births (R37 596.19 ± R548.11) was at least 75% higher than that of NVD.
“Twenty-five percent of beneficiaries paid at least R42 440.77 for a CS delivery in the private sector. Fees charged by specialists assisting with both CS and NVD have been increasing at above inflation annual rate of 8.6% and 8.8%, respectively. Due to involvement of a greater number of specialists in the CS delivery, the average cost of specialists for a CS delivery (R9 565.46 ± R260.00) were found to be significantly higher than the costs associated with NVD (R5 041.02 ± R136.45). Professional fees for CS accounted for 25.4% of the total average birth admission cost compared to 23.4% for NVD.”
[link url="https://www.timeslive.co.za/news/south-africa/2020-03-03-unnecessary-caesarean-section-births-are-popular-with-sas-medical-aid-members-claims-report/"]Full report in The Times[/link]
[link url="http://www.medicalschemes.com/files/Research%20Briefs/Caesarean%20section%20births%20-%20Research%20Brief%201%20of%202020.pdf"]CMS report[/link]