ALMOST 77% of babies covered by South African medical schemes are delivered by caesarean section – among the highest rates in the world, a new study by the Council for Medical Schemes (CMS) has found. According to the World Health Organisation, c-sections should only represent 10% to 15% of births. In South African state hospitals, the c-section was only around 26% in 2016.
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The CMS now wants urgent interventions to cut the c-section rate – which it thinks will ease the cost pressures on medical schemes.
C-sections are massively more expensive than vaginal births. The study found that 25% of c-sections to medical scheme members now cost more than R42,400 – compared to the price of a vaginal birth of between R16,900 to R25,400:
Source: Council for Medical Schemes
The average hospital visit was 67% more expensive for a c-section than for a vaginal delivery – R16,290 versus R27,086, respectively. The cost of medical specialist consultations for a c-section birth was almost 90% as expensive (R9,400 compared to less than R4,900). And the specialist prices are rising by almost 9% a year.
The CMS study found that the rate of c-sections was lower among members on comprehensive plans compared to hospital plans.
Hospital plans are cheaper than comprehensive plans, whose members are older and may have a “higher socioeconomic status (and) higher income levels” and therefore have better information about a c-section delivery, the study found.
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“C-section births continue to increase despite the known associated adverse health outcomes. These include increased risk of infection, surgical and anaesthetic complications, reduced likelihood of breastfeeding, and risks for the baby,” the study found – qualifying that a c-section can be a life-saving procedure.
But the CMS says that there are likely high levels of “medically unnecessary” c-sections among medical schemes. This is due to many factors, including the high rate of malpractice litigation when things go wrong in natural births. According to one expert, 98% of all legal claims related to obstetrics in South Africa involve vaginal births.
But the CMS also blames the low rate of natural births in part on the “high reimbursement rate” (presumably for hospitals and specialist healthcare providers), who can charge more for c-sections.
The CMS now wants urgent steps to reduce the incidence of c-sections among medical scheme members.
“Substantial reductions in the rates of caesarean birth will go a long way in reducing the cost of maternal health and the health system in general.”
It wants an investigation into alternative mechanisms to finance maternity care, so that “appropriate” incentives are provided to healthcare providers.
The CMS seems to believe that a move away for “fee-for-service” to “episode-based bundled payments” could be effective in bringing the c-section rate down. This would mean that medical schemes could pay a flat rate for a c-section, no matter what services were used, one expert told Business Insider SA.
Or – in a more extreme example – medical schemes could pay a flat rate per birth, no matter if it was a c-section or natural birth. This would help to lower the rate of c-sections, but it is unlikely to ever be adopted.
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