Financial Incentive, Medical Indication or Resource Prospect

How does the hospital policy impede the Cesarean Section Rate ?
AOCOG 2005 Oral Presentation

Chin-Hung, Lin

Cesarean section rate is the most valid measurement for the quality of obstetrical service but also disputable one. Many kinds of propositions have been proposed for interpreting why high Cesarean section rate is high including financial incentive and clinical indication. There are a lot of literatures about these factors above but they can’t have complete explanation for high cesarean section rate.
Under same risk circumstance and operating quality, the urgent cesarean sections are liable to consume more resource and cost more than those in regular according to the recent studies. With this conclusion, physicians will transfer some risky cases able to deliver in non-office time but with high probability of urgent Cesarean section into the regular operations. Therefore, the physicians can avert uncertainty of vaginal delivery and inconvenience of their long waiting.
As the decrease of childbirth in recent and regulation of global budget in Taiwan, the less fund and insufficient compensation have been advocated in the obstetrical aspect. The administrator of obstetrical room has to minimize the operating cost and cut the non-office-hour human resource down. The hospitals can also encourage physicians to operate those cases at office hours for saving the extra-ordinary expenditure and some non-office-hour reward spending.

Objective: The policy of resource allocation like cutting down non-office-hours human resource will do the delivery room more efficient and cost less. But it will also interfere the physician’s medical decision making and heave the Cesarean section rate.

Methods: Using the computer simulation with the model of two constructs of “Resource” & “Efficiency” under the randomization of patients type, labor time and operation probability in the formula below
Efficiency = F (Resource, Patient Type, Operation probability, Labor Duration and Time Beginning)
Modify the resource allocation by the policy under the control of Patient number and randomization the patient type, Labor Duration and Beginning of Labor to calculate the efficiency in each matrix.
Then we defined two situations “Mode A” (Normal resource allocation) and “Mode B” (Resource cut down in non-office hours), two policies adoption “Policy A” (Operate as usual) and “Policy B” (Switch some cases with high probability for urgent C/S into regular one). Under this circumstances and assumptions above, there will be (2×2) matrixes to exhibit the “Efficiency” in relationship with different “Resource” allocation under the confounding factor “Policy”.

Results: The simulation of four (2×2) kinds of situation revealed that “Mode A”& “Policy A” can play in good performance as before. “Mode A “& “Policy B” can do its best but it is unethical. “Mode B” and “Policy A” reveals that efficiency drops .By the other word, that uncertainty and systematic risks increase. Therefore, under the regulation and resource reallocation depicted like “Mode B”, they ought to adopt the “Policy B” in order to maintain the efficiency and prevent the uncertainty.

Conclusion: Not only the physician’s financial incentive, clinical patients’ indication but also the policy of hospital administration above will lead the upheaval of Cesarean section rate.