High rates of caesarean section in Chile do not reflect patient choice

December 14, 2000

Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study

In Chile, the rate of caesarean sections in women with private health insurance is double that of those in the public sector, yet this does not reflect patients' choice, according to a study in this week's BMJ.

Between 1995 and 1997, Susan Murray of University College London studied the day to day organisation, norms and relationships in private sector maternity care in Santiago, Chile, to examine the link between private health insurance - which has been promoted in Chile since the 1980s - and high rates of caesarean section.

Women with private obstetricians showed consistently higher rates of caesarean section than those cared for by midwives or doctors on duty in public or university hospitals. However, only a minority of women receiving private care reported that they had wanted this method of delivery.

Private health insurers require an obstetrician, rather than a midwife, to be the primary care provider. The need to provide such a high level of personalised care often conflicts with the demanding work schedules of obstetricians who take on private work to increase their incomes. As a result, the "programming" (or scheduling) of births by induction of labour or elective caesarean is a common time management strategy, says the author. Indeed, the study found that elective caesarean section is more common in women with private obstetricians (30-68%) than women not attended by a private obstetrician (12-14%).

Policies on healthcare financing can influence maternity care management and outcomes in unforseen ways, says the author. The prevailing business ethos in health care encourages such pragmatism among those doctors who do not have a moral objection to non-medical caesarean section.
-end-
Contact:

Susan Murray, Lecturer, Centre for International Child Health, Institute of Child Health, University College London, UK
Email: s.murray@ich.ucl.ac.uk

BMJ

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