Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis.

Hoxha, Ilir; Syrogiannouli, Lamprini; Luta, Xhyljeta; Tal, Kali; Goodman, David C; Da Costa, Bruno; Jüni, Peter (2017). Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis. BMJ open, 7(2), e013670. BMJ Publishing Group 10.1136/bmjopen-2016-013670

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OBJECTIVE Financial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the first year of records through February 2016. ELIGIBILITY CRITERIA To be eligible, studies had to report data to allow the calculation of ORs of CS comparing private for-profit hospitals with public or private non-profit hospitals in a specific geographic area. OUTCOMES The prespecified primary outcome was the adjusted OR of births delivered by CS in private for-profit hospitals as compared with public or private non-profit hospitals; the prespecified secondary outcome was the crude OR of CS in private for-profit hospitals as compared with public or private non-profit hospitals. RESULTS 15 articles describing 17 separate studies in 4.1 million women were included. In a meta-analysis of 11 studies, the adjusted odds of delivery by CS was 1.41 higher in for-profit hospitals as compared with non-profit hospitals (95% CI 1.24 to 1.60) with no relevant heterogeneity between studies (τ(2)≤0.037). Findings were robust across subgroups of studies in stratified analyses. The meta-analysis of crude estimates from 16 studies revealed a somewhat more pronounced association (pooled OR 1.84, 95% CI 1.49 to 2.27) with moderate-to-high heterogeneity between studies (τ(2)≥0.179). CONCLUSIONS CS are more likely to be performed by for-profit hospitals as compared with non-profit hospitals. This holds true regardless of women's risk and contextual factors such as country, year or study design. Since financial incentives are likely to play an important role, we recommend examination of incentive structures of for-profit hospitals to identify strategies that encourage appropriate provision of CS.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Hoxha, Ilir; Syrogiannouli, Lamprini; Luta, Xhyljeta; Tal, Kali 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:

Beatrice Minder Wyssmann

Date Deposited:

07 Mar 2017 10:54

Last Modified:

09 Sep 2017 19:51

Publisher DOI:

10.1136/bmjopen-2016-013670

PubMed ID:

28213600

Uncontrolled Keywords:

caesarean section; financial incentives; for-profit hospital; health services; medical practice variation; non-profit hospital

BORIS DOI:

10.7892/boris.96103

URI:

https://boris.unibe.ch/id/eprint/96103

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