Caesarean sections and private insurance: systematic review and meta-analysis.

Hoxha, Ilir; Syrogiannouli, Lamprini; Braha, Medina; Goodman, David C; Da Costa, Bruno R; Jüni, Peter (2017). Caesarean sections and private insurance: systematic review and meta-analysis. BMJ open, 7(8), e016600. BMJ Publishing Group 10.1136/bmjopen-2017-016600

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OBJECTIVE Financial incentives associated with private insurance may encourage healthcare providers to perform more caesarean sections. We therefore sought to determine the association of private insurance and odds of caesarean section. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase and The Cochrane Library from the first year of records through August 2016. ELIGIBILITY CRITERIA We included studies that reported data to allow the calculation of OR of caesarean section of privately insured as compared with publicly insured women. OUTCOMES The prespecified primary outcome was the adjusted OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. The prespecified secondary outcome was the crude OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. RESULTS Eighteen articles describing 21 separate studies in 12.9 million women were included in this study. In a meta-analysis of 13 studies, the adjusted odds of delivery by caesarean section was 1.13 higher among privately insured women as compared with women with public insurance coverage (95% CI 1.07 to 1.18) with no relevant heterogeneity between studies (τ(2)=0.006). The meta-analysis of crude estimates from 12 studies revealed a somewhat more pronounced association (pooled OR 1.35, 95% CI 1.27 to 1.44) with no relevant heterogeneity between studies (τ(2)=0.011). CONCLUSIONS Caesarean sections are more likely to be performed in privately insured women as compared with women using public health insurance coverage. Although this effect is small on average and variable in its magnitude, it is present in all analyses we performed.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Hoxha, Ilir; Syrogiannouli, Lamprini and Da Costa, Bruno

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2044-6055

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

24 Aug 2017 10:09

Last Modified:

06 Mar 2019 11:53

Publisher DOI:

10.1136/bmjopen-2017-016600

PubMed ID:

28827257

Uncontrolled Keywords:

caesarean section financial incentives health insurance health services medical practice variation private insurance

BORIS DOI:

10.7892/boris.105112

URI:

https://boris.unibe.ch/id/eprint/105112

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