Caesarean Sections in Beijing, China – Results from a Descriptive Study

Abstract

Objective: Caesarean section rates are increasing dramatically in China. The predominant contributor to the increase in China was the unnecessary Caesarean section. The objective of this study was to estimate the excess economic burden caused by unnecessary Caesarean sections vs. vaginal delivery for Beijing and all China.

Methods: The 33 476 obstetric medical case files from randomly selected 17 hospitals of Beijing in 2011 were taken for our descriptive approach. Based on the individual medical files and on a definition of what necessary and unnecessary Caesarean sections are, we sampled also the data for costs and length of stay for comparisons with vaginal deliveries. The Mann-Whitney U test and Pearson chi-square test statistics were used to test for significant difference in the analysis.

Results: The Caesarean section rate was 58.5% among all deliveries and that rate of unnecessary Caesarean sections was 71.5% among all the Caesarean sections but 41.8% among all deliveries in Beijing. The hospitalisation expenses of unnecessary Caesarean sections were 472 US$ higher than that of a vaginal delivery on average. The total excess economic burden caused by unnecessary Caesarean sections can be estimated to 38.97 million US$ for Beijing and to 3.29 billion US$ all over China in 2011. This is equivalent to the annual health expenditure of over 139 575 residents in Beijing and of 11 783 120 residents in China, respectively.

Conclusion: Socio-economic factors are possible reasons for the increase of unnecessary Caesarean section in China and more analytical attention should be paid to that problem in order to propose fitting practical reactions.

Zusammenfassung

Ziel: Die Kaiserschnitt-Rate steigt dramatisch in China. Der vorherrschende Faktor für die Zunahme waren unnötige Kaiserschnitte. Ziel dieser Studie war es, die wirtschaftliche Belastung durch unnötige Kaiserschnitte im Vergleich zu vaginalen Entbindung für Peking und ganz China zu schätzen.

Methodik: 33 476 geburtshilfliche medizinische Akten von 17 Krankenhäusern in Peking aus dem Jahr 2011 wurden ausgewertet, um die Situation von unnötigen Kaiserschnitten in Peking, China zu beschreiben und die wirtschaftliche Belastung, die sie im Vergleich zu vaginalen Entbindungen verursachten zu schätzen. Der Mann-Whitney U-Test und Pearson Chi-Quadrat-Test-Statistik wurden verwendet, um signifikanten Unterschied in der Analyse zu prüfen.

Ergebnisse: Schnittentbindungen waren 58,5% aller Entbindungen und unnötige Schnittentbindungen waren 71,5% damit, und 41,8% aller Entbindungen in Peking. Die Krankenhauskosten von unnötigen Kaiserschnitten waren im Durchschnitt 472 US$ höher als die der vaginalen Entbindung. Die Kosten der unnötigen Schnittentbindungen können auf 38,97 Million US$ für Beijing und 3,29 Billion US$ für das gesamte Land in 2011 geschätzt werden. Diese Summe entspricht den Gesamtausgaben für die Krankenversorgung von 139 575 Einwohnern in Beijing, bzw. etwa 11 783 120 Einwohnern in China.

Schlussfolgerung: Sozioökonomische Faktoren sind die möglichen Ursachen für diesen Sachverhalt und daher sollte größere analytische Aufmerksamkeit diesem Problem gewidmet werden, um geeignete praktische Schritte gegen die Verschwendung knapper Ressourcen durch unnötige medizinische Leistungen begründen zu können.

Key words

china - unnecessary Caesarean sections - excess economic burden

Schlüsselwörter

China - unnötige Schnittentbindungen - Kosten

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