The rate at which caesarean sections (c-sections) are happening in South Africa is among the highest in the world, this is according to a new report published by The Council of Medical Schemes.
In South Africa, c-section rates are currently sitting at an average of 78.57% for private hospitals and 44.10% for public hospitals. While many places across the world have a much lower c-section rate than SA, the upward trend has been seen across the globe.
Even though c-sections are generally safe, they do carry more risks when compared to vaginal delivery. The increased risks include possible pain or infection where the incision was made, an increased risk of blood loss and a longer recovery period due to having undergone a surgery. With this said, in certain instances a c-section can also be a life-saving procedure.
“Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons,” the World Health Organization says in a report on c-section rates.
“Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate.”
The cost of caesarian sections
C-sections are also significantly costlier than vaginal births. While vaginal births for women on medical schemes cost, on average, anything between R16 900 and R25 400, 25% of c-sections can cost upwards of R42 440.
Also, because of the need for more specialists in a c-section delivery, the average cost of specialists is around R9 565, while specialist costs for a vaginal delivery are at an average of R5 041.
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“The high frequency of caesarean deliveries in the private sector may be indicative of inefficient use of healthcare resources, supplier induced demand, lack of coordinated maternal care and poor choices by members of medical schemes,” the report says.
“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,” the report says.
The table below outlines the cost of vaginal delivery and c-section delivery per admissions in 2018:
The report points to the fact that the high level of c-sections could indicate unscrupulous dealings at play among hospitals and specialist healthcare providers.
It says that healthcare providers are incentivised by something called the ‘fee-for-service system’ to perform more c-sections because of the higher reimbursement rate compared to vaginal birth. The report also states that physicians who work independently are more likely to opt for a c-section delivery. Another reason could also have to do with the fact that most legal claims related to obstetrics in SA are linked to vaginal births – this can lead to medically unnecessary c-sections.
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“The convenience of being able to schedule births admissions is also an incentive for specialists to perform c-sections,” the report says. “Beneficiary factors include pregnant mothers choosing a c-section birth, believing that it is less painful and more convenient than natural vaginal delivery. Medical scheme membership [despite the high cost] makes this preference affordable.”
What needs to happen?
The Council of Medical Schemes is now calling for urgent intervention in bringing the number of c-sections down among medical schemes, which they believe will reduce the cost of maternal health.
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“Urgent steps must be taken to reduce what is likely to be high levels of medically unnecessary caesarean delivery rates in the medical schemes population,” the report concludes.
“Future studies must investigate the health outcomes associated with caesarean deliveries in the medical schemes’ population.”