An epidemic of avoidable caesarean deliveries in the private sector in India: Is physician-induced demand at play?. (November 2020)

• Record Type: Journal Article
• Authors: Bhatia, M.; Dwivedi, L.K.; Banerjee, K.; Dixit, P.
• Is Part Of: Social science & medicine. Volume 265(2020)
• Publication Date: 2020-11
• Subjects: C-Section -- Private sector -- Physician induced demand -- Financial incentives -- Maternal health -- Avoidable burden of C-Sections -- India -- Developing countries; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2020.113511
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Purpose and setting of research: Caesarean section (C-section) rates of over 15% suggest overuse of the surgery which may be difficult to justify on medical grounds. One important contributor to the rise in Csection rates is the rapid expansion of unregulated private-sector providers in number of settings. This study analyses the contribution of private sector in the rapid rise in Csection deliveries in India and the extent to which these can be justified on medical grounds. Methods: This is a cross sectional study design using National Family Health Surveys. Logistic regression and propensity score matching (PSM) analyses are performed. The main outcome measured is avoidable C-sections in the private sector. Principal findings: Our findings suggest that the rising trend in C-section rates in the private sector cannot be explained by medical reasons alone. The odds of C-section among women who chose to deliver in private was over 4 times higher than women who chose to delivery in public facilities. Despite, controlling for medical complications, women's characteristics and preferences, our PSM analysis suggest that the public-private gap has doubled over the years and that the difference cannot be explained by known determinants of C-section. Over supply of avoidable C-section to the extent of 21%, as a result of physician induced demand and perverse financial incentives was observed in the private sector. Conclusions: This paper attempts to understand the reason for the high C-section rates in the private sector in India and the extent to which these are avoidable. Our analysis supports the assumption that physician induced demand as a result of perverse financial incentives in the private sector is at play. Highlights: Rise in C-section rates is a major public health concern in many countries. Private sector is the main contributor to a rapid increase in C-sections in India. Odds of C-section among women who chose to deliver in private was over 4 times higher. High C-section rates in the private sector cannot be explained by known determinants. Over supply due to physician induced demand and perverse financial incentives.