Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2000 Dec 16;321(7275):1501-5.
doi: 10.1136/bmj.321.7275.1501.

Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study

S F Murray  1
Affiliations

Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study

S F Murray. BMJ. .

Abstract

Objectives: To explore the circumstances and factors that explain the association between private health insurance cover and a high rate of caesarean sections in Chile.

Design: Qualitative analysis of audiotaped in-depth interviews with obstetricians and pregnant women; quantitative analysis of data from face to face semistructured interview survey conducted postnatally (with women who had given birth in the previous 24-72 hours), and of a review of medical notes at a public hospital, a university hospital, and a private clinic.

Setting: Santiago, Chile.

Participants: Qualitative arm: 22 obstetricians, 21 pregnant women; quantitative arm: 540 postnatal women.

Main outcome measures: Rates of caesarean section in different types of institutions; consultants' views on private practice; work patterns in private practice; women's reasons for choosing private care; women's preferences on method of delivery.

Results: Private health insurance cover requires the primary maternity care provider to be an obstetrician. In the postnatal survey, women with private obstetricians showed consistently higher rates of caesarean section (range 57-83%) than those cared for by midwives or doctors on duty in public or university hospitals (range 27-28%). Only a minority of women receiving private care reported that they had wanted this method of delivery (range 6-32%). With the diversification in the healthcare market, most obstetricians now have demanding peripatetic work schedules. Private maternity patients are a lucrative source of income. The obstetrician is committed to attend these private births in person, and the "programming" (or scheduling) of births is a common time management strategy. The rate of elective caesarean sections was 30-68% in women with private obstetricians and 12-14% in women not attended by private obstetricians.

Conclusions: Policies on healthcare financing can influence maternity care management and outcomes in unforeseen ways. The prevailing business ethos in health care encourages such pragmatism among those doctors who do not have a moral objection to non-medical caesarean section.

PubMed Disclaimer

References

    1. Bélizan JM, Althabe F, Barros FC, Alexander S. Rates and implications of caesarean sections in Latin America: ecological study. BMJ. 1999;319:1397–1400. - PMC - PubMed
    1. Murray SF, Serani Pradenas F. Cesarean birth trends in Chile 1986 to 1994. Birth. 1997;24:258–263. - PubMed
    1. Miranda E, Scarpaci JL, Irarrázaval I. A decade of HMOs in Chile: market behaviour, consumer choice and the state. Health and Place. 1995;1:51–59.
    1. Seale C. The quality of qualitative research. London: Sage; 1999. pp. 1–210.
    1. Faúndes A, Cecatti JG. Which policy for caesarean sections in Brazil? An analysis of trends and consequences. Health Policy and Planning. 1993;8:33–42.

Publication types

MeSH terms