Private health care coverage and increased risk of obstetric intervention

Hdl Handle:
http://hdl.handle.net/10147/311946
Title:
Private health care coverage and increased risk of obstetric intervention
Authors:
Lutomski, Jennifer E; Murphy, Michael; Devane, Declan; Meaney, Sarah; Greene, Richard A
Citation:
BMC Pregnancy and Childbirth. 2014 Jan 13;14(1):13
Issue Date:
13-Jan-2014
URI:
http://dx.doi.org/10.1186/1471-2393-14-13; http://hdl.handle.net/10147/311946
Abstract:
Abstract Background When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria. Methods Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors. Results 403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43). Conclusions Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.
Item Type:
Article
Language:
en
Keywords:
PREGNANCY; CHILDBIRTH; PRIVATE HEALTH CARE

Full metadata record

DC FieldValue Language
dc.contributor.authorLutomski, Jennifer Een_GB
dc.contributor.authorMurphy, Michaelen_GB
dc.contributor.authorDevane, Declanen_GB
dc.contributor.authorMeaney, Sarahen_GB
dc.contributor.authorGreene, Richard Aen_GB
dc.date.accessioned2014-01-28T10:45:56Z-
dc.date.available2014-01-28T10:45:56Z-
dc.date.issued2014-01-13-
dc.identifier.citationBMC Pregnancy and Childbirth. 2014 Jan 13;14(1):13en_GB
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2393-14-13-
dc.identifier.urihttp://hdl.handle.net/10147/311946-
dc.description.abstractAbstract Background When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria. Methods Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors. Results 403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43). Conclusions Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.-
dc.language.isoenen
dc.subjectPREGNANCYen_GB
dc.subjectCHILDBIRTHen_GB
dc.subjectPRIVATE HEALTH CAREen_GB
dc.titlePrivate health care coverage and increased risk of obstetric interventionen_GB
dc.typeArticleen
dc.language.rfc3066en-
dc.rights.holderJennifer E Lutomski et al.; licensee BioMed Central Ltd.-
dc.description.statusPeer Reviewed-
dc.date.updated2014-01-22T12:15:49Z-
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