scholarly journals The true relative financial cost of Planned Caesarean Birth (PCB) versus Planned Vaginal Birth (PVB) in England for the year 2018/19 taking into account litigation and compensation for harm: a sensitivity analysis.

2020 ◽  
Author(s):  
Jonathan West ◽  
Myles Taylor ◽  
Michael Magro
Keyword(s):  
Sensitivity Analysis ◽  
Mode Of Delivery ◽  
Design Sensitivity ◽  
Vaginal Birth ◽  
Cost Advantage ◽  
Financial Cost ◽  
Caesarean Birth ◽  
Financial Costs ◽  
Mode Of Birth ◽  
Additional Costs

OBJECTIVE: To determine the true financial costs of Planned Caesarean Section and Planned Vaginal Birth in England for the year 2018/19 after accounting for litigation and compensation for harm (LCFH) DESIGN: Sensitivity analysis BACKGROUND: Average base costs per delivery remitted to NHS maternity providers for Planned Caesarean Birth (PCB) and Planned Vaginal Birth (PVB) in 2018/19 were £3,948 and £3,270 respectively leading to a perception that PCB is more costly than PVB. Indemnity costs potentially related to planned mode of delivery, however, add an average of £1,571/delivery to overall costs. METHOD: Retrospective analysis of costs according to planned mode of birth was performed based on data and previous research published by NHS Resolution and NHS England. Weighting of results according to PCB and PVB rates was performed in a manner similar to the sensitivity analysis of PCB v PVB (without accounting for LCFH) performed by the National Institute for Health and Care Excellence (NICE) in 2011 RESULTS: Additional costs of LCFH resulted in revised costs of £4,245 and £5,030 for PCB and PVB respectively – a cost advantage of £785 per delivery in favour of PCB. CONCLUSION: Providers should not be discouraged from offering or women refused PCB on grounds of cost.

scholarly journals Women's Views on Mode of Birth in Public Hospitals in Argentina: Inputs From a Formative Research to Optimize the Use of Caesarean Section

2021 ◽  
Author(s):  
Carla Perrotta ◽  
Mariana Romero ◽  
Yanina Sguassero ◽  
Natalia Righetti ◽  
Celia Gialdini ◽  
...  
Keyword(s):  
Pain Management ◽  
Caesarean Section ◽  
Quantitative Methods ◽  
Mode Of Delivery ◽  
Formative Research ◽  
Vaginal Birth ◽  
Public Hospitals ◽  
Postpartum Women ◽  
Maternity Hospitals ◽  
Mode Of Birth

Abstract BackgroundThis paper reports on women's perspectives on the birth mode in five public maternity hospitals in Argentina. The study is a formative research study component aimed at tailoring interventions to reduce unnecessary caesarean section (CS) use. MethodsParticipants were postpartum women aged ≥15 years old in five hospitals in the provinces of Salta, Corrientes, Tucuman, Santa Fe and Buenos Aires City. Hospitals completed an institutional survey indicating the availability of obstetric services. The fieldwork was carried out from November 2018 to June 2019. Trained interviewers gathered data on obstetric history, companionship, mode of delivery preferences, and general opinion on vaginal and caesarean section births through semi-structured interviews. The interviews were coded and analysed with standard quantitative methods. ResultsThe five hospitals had a CS rate between 29.2 and 45.5. Four institutions indicated limited access to epidural and other pain management strategies and a restricted antenatal education schedule. The sample included 621 postpartum women with a mean age of 26 years (± SD 6). 60% of them had a vaginal birth (VB). More than 90% of women in three hospitals favoured VB, and in two, 67% (p<0001). CS preference was associated with giving birth in those two hospitals and the numbers of miscarriages adjusting by maternal age and previous pregnancies. The reasons for preferring a VB included faster recovery, feeling ready, and considering it more natural. Most women chose CS as the best mode of birth to avoid birth pain. CS disadvantages included post-procedure pain, dependence on others to take care of her or the baby afterwards, and prolonged time in the hospital. Six out of ten women would have liked to be asked by their providers about the MOB of choice. ConclusionsWomen giving birth in public maternity hospitals of Argentina preferred a vaginal delivery to a caesarean section. There is an ongoing need to improve access to pain management during labour and vaginal birth and include women's opinions along the decision-making process for selecting the mode of childbirth. Hospitals with a lower preference for VB will require additional efforts to understand women's needs and values. Trial registration: IS002316

scholarly journals Payment mechanism for institutional births in Nepal

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Ashish KC ◽  
Mats Målqvist ◽  
Amit Bhandari ◽  
Rejina Gurung ◽  
Omkar Basnet ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Mode Of Delivery ◽  
Transportation Cost ◽  
Universal Coverage ◽  
Medical Services ◽  
Incentive Scheme ◽  
Duration Of Stay ◽  
Caesarean Birth ◽  
Demand Side Financing ◽  
Mode Of Birth

Abstract Background Since the Millennium Development Goal era, there have been several efforts to increase institutional births using demand side financing. Since 2005, Government of Nepal has implemented Maternity Incentive Scheme (MIS) to reduce out of pocket expenditure (OOPE) for institutional birth. We aim to assess OOPE among women who had institutional births and coverage of MIS in Nepal. Method We conducted a prospective cohort study in 12 hospitals of Nepal for a period of 18 months. All women who were admitted in the hospital for delivery and consented were enrolled into the study. Research nurses conducted pre-discharge interviews with women on costs paid for medical services and non-medical services. We analysed the out of pocket expenditure by mode of delivery, duration of stay and hospitals. We also analysed the coverage of maternal incentive scheme in these hospitals. Results Among the women (n-21,697) reporting OOPE, the average expenditure per birth was 41.5 USD with 36 % attributing to transportation cost. The median OOPE was highest in Bheri hospital (60.3 USD) in comparison with other hospitals. The OOPE increased by 1.5 USD (1.2, 1.8) with each additional day stay in the hospital. There was a difference in the OOPE by mode of delivery, duration of hospital-stay and hospital of birth. The median OOPE was high among the caesarean birth with 43.3 USD in comparison with vaginal birth, 32.6 USD. The median OOPE was 44.7 USD, if the women stayed for 7 days and 33.5 USD if the women stayed for 24 h. The OOPE increased by 1.5 USD with each additional day of hospital stay after 24 h. The coverage of maternal incentive was 96.5 % among the women enrolled in the study. Conclusions Families still make out of pocket expenditure for institutional birth with a large proportion attributed to hospital care. OOPE for institutional births varied by duration of stay and mode of birth. Given the near universal coverage of incentive scheme, there is a need to review the amount of re-imbursement done to women based on duration of stay and mode of birth.

scholarly journals A cost analysis to address issues of budget constraints on the implementation of the indoor residual spray programme in two districts of Maputo Province, Mozambique

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Neide Canana
Keyword(s):  
Sensitivity Analysis ◽  
Cost Analysis ◽  
Financial Analysis ◽  
Indoor Residual Spraying ◽  
Economic Cost ◽  
Cost Information ◽  
Financial Cost ◽  
Provider Perspective ◽  
The Government ◽  
The Cost

Abstract Background It is frequently said that funding is essential to ensure optimal results from a malaria intervention control. However, in recent years, the capacity of the government of Mozambique to sustain the operational cost of indoor residual spraying (IRS) is facing numerous challenges due to restrictions of the Official Development Assistance. The purpose of the study was to estimate the cost of IRS operationalization in two districts of Maputo Province (Matutuíne and Namaacha) in Mozambique. The evidence produced in this study intends to provide decision-makers with insight into where they need to pay close attention in future planning in order to operationalize IRS with the existent budget in the actual context of budget restrictions. Methods Cost information was collected retrospectively from the provider perspective, and both economic and financial costs were calculated. A “one-way” deterministic sensitivity analysis was performed. Results The average economic costs totaled US$117,351.34, with an average economic cost per household sprayed of US$16.35, and an average economic cost per person protected of US$4.09. The average financial cost totaled US$69,174.83, with an average financial cost per household sprayed and per person protected of US$9.84 and US$2.46, respectively. Vehicle, salary, and insecticide costs were the greatest contributors to overall cost in the economic and financial analysis, corresponding to 52%, 17%, and 13% in the economic analysis and 21%, 27%, and 22% in the financial analysis, respectively. The sensitivity analysis was adapted to a range of ± (above and under) 25% change. There was an approximate change of 14% in the average economic cost when vehicle costs were decreased by 25%. In the financial analysis, the average financial cost was lowered by 7% when salary costs were decreased by 25%. Conclusions Altogether, the current cost analysis provides an impetus for the consideration of targeted IRS operationalization within the available governmental budget, by using locally-available human resources as spray operators to decrease costs and having IRS rounds be correctly timed to coincide with the build-up of vector populations.

scholarly journals How birth outcomes among a cohort of Guatemalan women with a history of prior cesarean vary by mode or birth across different interpregnancy intervals

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Margo S. Harrison ◽  
Ana Garces ◽  
Lester Figueroa ◽  
Jamie Westcott ◽  
Michael Hambidge ◽  
...  
Keyword(s):  
Mode Of Delivery ◽  
Secondary Analysis ◽  
Vaginal Birth ◽  
Global Network ◽  
Vaginal Birth After Cesarean ◽  
Cesarean Birth ◽  
Dilation And Curettage ◽  
History Of ◽  
Interpregnancy Intervals ◽  
Hospital Births

Abstract Objectives Our objectives were to analyze how pregnancy outcomes varied by cesarean birth as compared to vaginal birth across varying interpregnancy intervals (IPI) and determine if IPI modified mode of birth. Methods This secondary analysis used data from a prospective registry of home and hospital births in Chimaltenango, Guatemala from January 2017 through April 2020, through the Global Network for Women’s and Children’s Health Research. Bivariate comparisons and multivariable logistic regression were used to answer our study question, and the data was analyzed with STATA software v.15.1. Results Of 26,465 Guatemalan women enrolled in the registry, 2794 (10.6%) had a history of prior cesarean. 560 (20.1%) women delivered by vaginal birth after cesarean with the remaining 2,233 (79.9%) delivered by repeat cesarean. Repeat cesarean reduced the risk of needing a dilation and curettage compared to vaginal birth after cesarean, but this association did not vary by IPI, all p-values > p = 0.05. Repeat cesarean delivery, as compared to vaginal birth after cesarean, significantly reduced the likelihood a woman breastfeeding within one hour of birth (AOR ranged from 0.009 to 0.10), but IPI was not associated with the outcome. Regarding stillbirth, repeat cesarean birth reduced the likelihood of stillbirth as compared to vaginal birth (AOR 0.2), but again IPI was not associated with the outcome. Conclusion Outcomes by mode of delivery among a Guatemalan cohort of women with a history of prior cesarean birth do not vary by IPI.

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