The study was conducted to explore the factors and circumstances that explain the linkage between the insurance cover of the private health and the caesarian section high rates in Chile. The study applied both qualitative and quantitative analysis in the research design. In the qualitative analysis, the study analyzed the interviews with the pregnant women and obstetricians. Similarly, on the quantitative analysis, the study analyzed the data from the postnatal on the women who in the previous 24 to 72 hours had given birth.
Protection of participants
The study tools applied in the study included face to face interview survey and audio taped interviews to the participants. Furthermore, medical records were reviewed to obtain data on care management and experiences of women in labor care. To protect the participants and to be ethical, the researcher obtained approval from Chile health ministry before conducting the study. Furthermore, agreement to be involved into the study was gotten from the director of every study site
Data collection methods
The methods of data collection included face to face interview survey and audio taped interviews with the participants. The study also applied maximum variation opportunistic sampling approach to the obstetricians to make sure extensive range of demographic attitudes, work contexts, experiences and characteristics to caesarian section. The similar method was applied to the post natal women to ensure a wide range of parity, age and socio economic status. This was believed to eliminated biasness and ethical since information was confidential
Why private health insurance is linked to the caesarian section’s high rate
Data analysis and data management of the quantitative study
The quantitative part of the study was done on 540 post natal women whom the article will analyze. The semi-structured questionnaire about the expectations of the women and their experiences during the childbirth was administered 24 to 72 hours after the delivery by the researcher.
The results indicated that the views of the women on private women care with their private obstetricians made a choice of a doctor through a relative or a friend recommendation (64% of the participants surveyed from the private clinic, and 80% from the university and public hospitals) (Murray, 2000). Among the women surveyed, the data also indicated that higher percentage of women preferred private clinic than the university or public hospital because they believed the clinical care and personal care was better and also because it was the condition of the health insurance.
On the other hand, the post natal women were also interviewed on preference of delivery method. When asked during the survey whether they had wanted a caesarian section at any point in their pregnancy, about 6% to 32% of the post natal women receiving private care from their obstetricians reported that they had. Moreover, the resulted from the private clinic where about 70% of the surveyed women had undergone a caesarian section before, only 18% showed that they had wanted a caesarian section (Murray, 2000).
Discussion/interpretation of findings and suggestions offered
In critical analysis of the study results, it is clear that the healthcare financing policies in Chile have influenced the maternity care management and the outcomes in many unforeseen ways. To begin, in Chile, the private health insurance cover normally requires the maternity care primary provider to be an obstetrician, and the women having private obstetricians indicated higher rates of caesarian section compared to those of the public and university hospitals. This according to Murray (2000) cannot be explained as a reflection of the choice of a patient in the private sector. Murray (2000) asserted that the choice of the patient is always an issue that is complex, but there exists few grounds for the patients’ choice being the sole explanation of the high caesarian sections in the private sector in Chile.
The question being raised from the quantitative findings is whether the high rates of caesarian section in the private sector is simply a reflection of the a consensus in the establishment of the obstetric in Chile, that this is the belief in Chile that because of advances in fetal wellbeing monitoring, caesarian section should the optimal delivery method for most women. However, Murray (2000) contrasts that school of thought with statistics from one of the most exclusive hospitals in Santiago, Clínica Las Condes. From 1991, the hospital has reported a continuous steady decline in the caesarian section rates.
To discourage caesarian section high rates, the insurance schemes in Chile for the five years prior to the study, had not paid more the obstetricians for performing caesarian sections in comparison to the vaginal deliveries. In the private sector also, the care package are standard also irrespective of the delivery type. However, caesarian section is opted for because it provides maximum efficient in time use and to offer private care to other patients.
In conclusion, the results of the study indicated that insurance covers of private health required that the primary provider of maternity care to be an obstetrician. However, in the postnatal survey, the women who with private obstetricians showed high rates of caesarian section consistently compared to those cared for by the doctors on duty or midwives in university or public hospitals. Patients often incur extra costs from after the surgery and therefore hospitals benefit. Obstetricians also do private work to increase their income since the health insurance demands that their clients to have an obstetrician
Murray, S. F. (January 01, 2000). Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study. Bmj (clinical Research Ed.), 321, 7275, 1501-5.
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