E3 Journal of Medical Research

E3 Journal of Medical Research Vol. 1 (6) pp. 084-090, July 2012; © E3 Journals; ISSN 2276-9900

Caesarean section rates in large medical schemes in South Africa: An explorative descriptive study

Abstract

Caesarean deliveries are not funded by medical schemes unless clinically motivated by the provider. Although they are not covered by schemes, caesarean sections rates in the private sector are reported to be amongst the highest in the world, these procedures are also reported to be costly with an average cost of more than twenty five thousand rand per procedure. The objective of this study was to examine caesarean section rates in large medical schemes in South Africa; to explore selected factors that may be associated with these increasing rates. Multivariate analysis of variance (MANOVA) was conducted to measure CS rate characteristics to factors such as scheme type, pregnancy rates in schemes, the proportion of female beneficiaries in schemes, and the average age of beneficiaries. The average age of female beneficiaries in open schemes was higher than in restricted schemes at 33.3 years compared to 29.9 years (p=0.0180). Open schemes offered more benefit options compared to restricted schemes: on average eight benefit options compared to three (p=0.0048). The median caesarean rates per 1000 deliveries were 686.1 IQR (634.2–730.5). The data presented revealed that pregnancy rates, proportion of female beneficiaries in the schemes and the average age of beneficiaries had no effect on increasing caesarean rates. The findings of the current paper indicate that caesarean rates were relatively similar in open and restricted schemes, but consistently higher in open schemes. Selected covariates such as the average age of beneficiaries and pregnancy rates had no effect on the increasing caesarean section rates. Suggesting that other covariates such as clinical notes and provider perspective on CS rates need to be explored further, lastly, alternative initiatives to curb caesarean rates that have been explored in other countries could add value in South African medical schemes.

Keywords: Caesarean Section; Normal Vaginal Delivery; Prescribe Minimum Benefits