Accounting for the Rising Caesarean Section Rate in Canada: What Are the Roles of Changing Needs, Practices, and Incentives?

2021 ◽  
Author(s):  
Michael Baker ◽  
Maripier Isabelle ◽  
Mark Stabile ◽  
Sara Allin
Keyword(s):  
Caesarean Section ◽  
Financial Incentives ◽  
Health Care Systems ◽  
Caesarean Section Rate ◽  
The United States ◽  
World Health ◽  
Strong Increase ◽  
Primary Determinant ◽  
Care Systems ◽  
Health Organization

In most high-income countries, including Canada, the share of births by Caesarean section (C‑section) has risen over the past decades to far exceed World Health Organization recommendations of the proportion justified on medical grounds (15 percent). Although unnecessary C-sections represent an important cost for health care systems, they are not associated with clear benefits for the mother and the child and can sometimes represent additional risks. Drawing on administrative records of nearly four million births in Canada, as well as macro data from the United States and Australia, we provide a comprehensive account of rising C-section rates. We explicitly consider the contributions of the main factors brought forward in the policy literature, including changing characteristics of mothers, births, and physicians as well as changing financial incentives for C-section deliveries. These factors account for at most one-half of the increase in C-section rates. The majority of the remaining increase in C-sections over the period 1994–2011 occurred in the early 2000s. We suggest that some event or shock in the early 2000s is likely the primary determinant of the recent strong increase in the C-section rate in Canada.

scholarly journals Los incentivos y actores de los Sistemas de Salud de Costa Rica, Estados Unidos, Canadá, Chile y Ecuador - 2015

2016 ◽  
Vol 18 (2) ◽  
pp. 385
Author(s):  
Samantha Carolina Camargo-García ◽  
Aura Maritza Cortés-Bermeo ◽  
Andrea Katherine Abreu-Flechas ◽  
Manuel Eliecer Suárez-Rativa ◽  
Wilson Giovanni Jiménez-Barbosa
Keyword(s):  
Costa Rica ◽  
Health Care Systems ◽  
The United States ◽  
World Health ◽  
Public And Private ◽  
Two Factors ◽  
El Sistema ◽  
Care Systems ◽  
Health Organization ◽  
Strategic Perspective

ResumenAnte los diferentes sistemas de salud propuestos en cada país surge la necesidad de analizar la participación de cada uno de los elementos que lo componen. Este análisis se realiza con el fin de identificar y analizar los actores que intervienen en los sistemas de salud, especialmente, el uso de incentivos y la relación intersectorial que entre estos existe. Para ello, se llevó a cabo un estudio cualitativo descriptivo, mediante una revisión bibliográfica de los sistemas implementados en Costa Rica, Estados Unidos, Canadá, Chile y Ecuador. Se tuvieron en cuenta dos factores: el sistema de salud, definido por la Organización Mundial de la Salud como la suma de todas las organizaciones, instituciones y recursos empleados, cuyo objetivo consiste en mejorar la salud. El segundo, los incentivos, que brindan una motivación a los trabajadores, mejorando sus expectativas frente al trabajo y la manera de ejecutarlo, favoreciendo el cumplimiento de metas establecidas por las empresas. Como resultado, se encontró que en los sistemas de salud expuestos, si bien existen similitudes en relación con su desarrollo e implementación, también hay profundas diferencias, en especial, en la participación de actores públicos y privados. Conclusión: los incentivos existentes en los sistemas de salud estudiados no tienen un enfoque estratégico que articule a los actores en pro de la salud y el bienestar de la población. AbstractBefore the different systems of health proposed in every country there arises the need to analyze the participation of each one of the elements that compose it. This analysis is realized in order identify and to analyze the actors who intervene in the systems of health, especially, the use of incentives and the intersectorial relation that between these exists. For it, there was carried out a qualitative descriptive study, by means of a bibliographical review of the systems implemented in Costa Rica, The United States, Canada, Chile and Ecuador. Two factors were born in mind: the system of health, defined by the World Health Organization (WHO) like the sum of all the organizations, institutions and used resources, which aim consists of improving the health. The second one, the incentives, that offer a motivation to the workers, improving his expectations opposite to the work and the way of executing it, favoring the fulfillment of goals established by the companies. As result, one found that, in the systems of health exposed, though similarities exist in relation with his development and implementation, also there are deep differences, especially, in the participation of public and private actors. Conclusion, incentives in health care systems do not have strategic perspective so that there are many problems to obtain wellbeing for all citizens.

scholarly journals THE WAY THE HEALTH CARE SYSTEM IN UKRAINE LOOKS LIKE: INTERNATIONAL PRACTICES WITHIN NATIONAL REALITIES

2019 ◽  
Vol 72 (4) ◽  
pp. 685-691
Author(s):  
Borys O. Lohvynenko ◽  
Roman V. Myroniuk ◽  
Olexander P. Svitlychnyy ◽  
Aleksey Y. Prokopenko ◽  
Lidija I. Kalenichenko
Keyword(s):  
Health Care ◽  
Health Care System ◽  
National Health ◽  
Health Care Systems ◽  
World Health ◽  
National Health Care ◽  
National Health Care System ◽  
Care Systems ◽  
Health Organization ◽  
Care System

Introduction: Nowadays there is the transformation of the national health care system in Ukraine, the ultimate goal of which is to create a modern, competitive model of medical care of citizens on the basis of forming packages of free medical services. However, the model adopted by Ukraine is in contradiction with national legislation in part of free medical aid guaranteed by the Art. 49 of the Constitution of Ukraine, and fragmentary considers positive international practices. The aim of the paper is to determine the mistakes of the reform of the Ukrainian health care system and to reveal the positive international practices of the organization of health care systems that can be implemented in Ukraine. Materials and methods: National and international legislation, official web resources of the executive authorities of Ukraine, statistics of the World Health Organization, materials of journalistic and scientific periodicals are the materials for the research of the health care system in Ukraine in comparison with international practices. Research methods are cross-sectoral, complex statistical, comparative, generalization, analysis and synthesis. In order to obtain the results, the authors have conducted a critical analysis of the current norms of the national Ukrainian legislation in the health care sector. Review: The authors of the article have studied the main disadvantages of the national health care system in accordance with the concept of reforming the medical sector. Positive international practices that can be implemented into Ukrainian system for the real improvement of medical human rights in Ukraine have been revealed. Conclusions: It has been proved that the ongoing reform of the health care system in Ukraine needs to be reviewed and optimized. It has been offered to consolidate a perspective model of the Ukrainian health care system, its principles and guarantees of immunity at the legislative level.

scholarly journals Implementation of the Integrated Care of Older People (ICOPE) App in Primary Care: New Technologies in Geriatric Care during Quarantine of COVID-19 and Beyond

2020 ◽  
pp. 1-2
Author(s):  
D. Sanchez-Rodriguez ◽  
C. Annweiler ◽  
S. Gillain ◽  
B. Vellas
Keyword(s):  
New Technologies ◽  
Health Care Systems ◽  
Action Plan ◽  
Credible Interval ◽  
Therapeutic Interventions ◽  
World Health ◽  
Global Priority ◽  
Care Systems ◽  
Novel Coronavirus ◽  
Health Organization

The COVID-19 pandemic due to a novel coronavirus (SARS-CoV-2) in December 2019 has rapidly spread worldwide. The mortality rate is about 2.3% in general population, with high human-to-human transmission of 0.41 (credible interval [0.27, 0.55]), and nasopharyngeal asymptomatic carriers act as vectors within the population (1). The World Health Organization (WHO) declared the pandemic on March 2020, and established objectives and action plan. First, WHO aimed at limiting the transmission of SARS-CoV-2, which required large isolation actions (country borders lockdown and individual quarantine). Second, WHO aimed at guiding and supporting the different health care systems across countries. Finally, developing therapeutic interventions appeared as a global priority as available evidence were still scarce (1). More than 860 clinical trials are ongoing worldwide.

scholarly journals Caesarean Section Rates and Activity-Based Funding in Northern Norway: A Model-Based Study Using the World Health Organization’s Recommendation

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Jan Norum ◽  
Tove Elisabeth Svee
Keyword(s):  
Caesarean Section ◽  
Financial Incentives ◽  
Financial Incentive ◽  
Economic Consequences ◽  
World Health ◽  
Birth Registry ◽  
Northern Norway ◽  
Model Based ◽  
The World ◽  
Health Organization

Objective. Caesarean section (CS) rates vary significantly worldwide. The World Health Organization (WHO) has recommended a maximum CS rate of 15%. Norwegian hospitals are paid per CS (activity-based funding), employing the diagnosis-related group (DRG) system. We aimed to document how financial incentives can be affected by reduced CS rates, according to the WHO’s recommendation. Methods. We employed a model-based analysis and included the 2016 data from the Norwegian Patient Registry (NPR) and the Medical Birth Registry of Norway (MBRN). The vaginal birth rate and CS rates of each hospital trust in Northern Norway were analyzed. Results. There were 4,860 deliveries and a 17.5% CS rate (range 13.9–20.3%). The total funding of the deliveries was €16,351,335 (CS: €6,389,323; vaginal births: €9,962,012). The CS rate varied significantly and was lower in the southern region (P<0.002). Consequently, the introduction of a cutoff at a 15% CS rate would gain the two southern hospital trusts by a budget increase of 0.2%. The two northern ones would experience 6.4% less resources. A total of €644,655 could be allocated to further quality and safety initiatives in obstetrics. Conclusion. The economic consequences of the model-based financial incentive were low, but probably sufficient to get the necessary attention and influence on the CS rate. Recommendations. A financial incentive for the reduction of CS rates should be tested as a supplement to other instruments.

scholarly journals Unfavorable Mortality-To-Incidence Ratio of Lung Cancer Is Associated with Health Care Disparity

2018 ◽  
Vol 15 (12) ◽  
pp. 2889 ◽  
Author(s):  
Cheng-Yu Huang ◽  
Kwong-Kwok Au ◽  
Sung-Lang Chen ◽  
Shao-Chuan Wang ◽  
Chi-Yu Liao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Health Care Systems ◽  
Health Care Expenditures ◽  
Good Health ◽  
World Health ◽  
Incidence And Mortality ◽  
Care Systems ◽  
Adequate Quality ◽  
Health Organization

The mortality-to-incidence ratio (MIR) is associated with the clinical outcome of cancer treatment. For several cancers, countries with relatively good health care systems have favorable MIRs. However, the association between lung cancer MIR and health care expenditures or rankings has not been evaluated. We used linear regression to analyze the correlation between lung cancer MIRs and the total expenditures on health/gross domestic product (e/GDP) and the World Health Organization (WHO) rankings. We included 57 countries, for which data of adequate quality were available, and we found high rates of incidence and mortality but low MIRs in more developed regions. Among the continents, North America had the highest rates of incidence and mortality, whereas the highest MIRs were in Africa, Asia, Latin America, and the Caribbean. Globally, favorable MIRs correlated with high e/GDP and good WHO ranking (regression coefficient, −0.014 and 0.001; p = 0.004, and p = 0.014, respectively). In conclusion, the MIR for lung cancer in different countries varies with the expenditure on health care and health system rankings.

Oral Health Care Systems: An International Collaborative Study Coordinated by the World Health Organization

1987 ◽  
Vol 8 (1) ◽  
pp. 125
Author(s):  
Max H. Schoen ◽  
Harald A. Arnljot ◽  
David E. Barmes ◽  
Lois K. Cohen ◽  
Peter B. V. Hunter ◽  
...  
Keyword(s):  
Health Care ◽  
Oral Health ◽  
World Health Organization ◽  
Health Care Systems ◽  
Collaborative Study ◽  
World Health ◽  
The World ◽  
Care Systems ◽  
Health Organization ◽  
International Collaborative Study

The WHO European Program of Health Legislation and the Health for All Policy

1986 ◽  
Vol 12 (3-4) ◽  
pp. 441-460
Author(s):  
Geneviève Pinet
Keyword(s):  
Health Policy ◽  
National Health ◽  
Health Care Systems ◽  
International Health ◽  
World Health ◽  
Regional Office ◽  
Country Level ◽  
Care Systems ◽  
Health Organization ◽  
Health Legislation

AbstractThe purpose of this paper is to provide a comprehensive review of the work of the World Health Organization (WHO), begun a decade ago in Europe, in the field of health legislation. This program is the result of the interaction between two important factors: the trends in national health policy and legislation at the country level, and the implementation of the Health for All policy, which has been collectively adopted by the European Member States in various WHO fora.Health legislation has proved to be a valuable tool in supporting National Health Policies in European countries and a key element in international health activities. The paper will be presented in three main parts. The first examines the legislative implications of the Health for All policy and strategy. The second gives an overview of developments in health legislation in Europe, focusing on national achievements in three areas in which change is necessary to achieve Health for All: health care systems, the environment, and lifestyles. The third part gives an account of activities carried out by the Regional Office for Europe of WHO in the health legislation field, recalls the organization of the first WHO medium-term program in this field, and summarizes its four current subprograms on health policy, health situation, exchange of information, and training. The conclusion briefly outlines the prospects for further developments in Europe.

scholarly journals Role of mhealth in the management of Tuberculosis: A new approach to improve adherence

2020 ◽  
Vol 11 (4) ◽  
pp. 5560-5568
Author(s):  
Rajavardhana T ◽  
Rajanandh M G ◽  
Geethavani M ◽  
Sreedhar V
Keyword(s):  
Health Care Systems ◽  
Treatment Compliance ◽  
World Health ◽  
Single Individual ◽  
Success Rates ◽  
Tb Treatment ◽  
Care Systems ◽  
New Ideas ◽  
Health Accounts ◽  
Health Organization

Compliance with Tuberculosis (TB) treatment is essential in enhancing singly and public health as well. may come out with suffering, disease worsening, and mortality and also leads to increased economic burden to the patients. Through this article, we want to explore new ideas to strengthen medication adherence with the assistance of approaches to monitor and enhance TB patient's medication-taking behavior. have more success rates in particular parts, whereas its limitations in improving the adherence can be understood in the world health organization End Tuberculosis plan of action. To provide disease and treatment-related education to the patients, apps should be of educational worth to patients by delivering classified information, which is easily accessible to the patients and caregivers. Hurdles to TB treatment compliance are noteworthy and multiple. Mobile health accounts for an arising field with significant promises to locate barriers, thus enhancing every single individual and community health and health care systems planning.

scholarly journals A profile of Caesarean sections performed at a district hospital in Tshwane, South Africa

2019 ◽  
Vol 61 (6) ◽  
Author(s):  
I. Govender ◽  
C. Steyn ◽  
O. Maphasha ◽  
A. T. Abdulrazak
Keyword(s):  
Caesarean Section ◽  
South African ◽  
District Hospital ◽  
Caesarean Section Rate ◽  
Working Hours ◽  
World Health ◽  
Maternal Characteristics ◽  
Sub Saharan ◽  
Health Organization ◽  
The Ideal

Introduction: Caesarean section (CS) is a common obstetric procedure that prevents neonatal and maternal death when performed correctly if indicated; however, CS can give rise to complications that lead to maternal and perinatal morbidity and mortality. Rates of CS are increasing worldwide, although the World Health Organization (WHO) has indicated an ideal rate of 5–15%. South African CS rates are higher than the ideal.Methods: Maternity records of 2015 were reviewed at Odi District Hospital (ODH) to assess whether ODH complies with the ideal CS rate. In this study, extracted data include date and time of CS, maternal age, parity, gestational age, total number of previous CSs, elective or emergency, indications, anaesthesia used and registration of the surgeon.Results: There were 3 336 deliveries and 1 064 CSs (32%). The majority of women were aged from 19 to 34 years (59%), 72.8% were multiparous and 54% between 37–39 weeks’ gestation. The most common (40.1%) overall and emergency indication was foetal distress. Most CSs were emergencies (61.70%). Most elective CSs were because of a previous CS and spinal anaesthesia was used in 91.73%. Medical officers performed most of the CSs (79.0%) during working hours. The CS rate of 32% was significantly higher than the ideal 5–15% and higher than in other sub-Saharan countries with similar maternal characteristics. Indications for emergency and elective CSs were similar to previous research.Conclusion: The Caesarean section rate at ODH is higher than the recommended rate. Potential CSs therefore need to be evaluated more intensely to assess the true need for surgical intervention.

scholarly journals A near-miss case of obstetric haemorrhage managed successfully

2016 ◽  
Vol 6 (1) ◽  
pp. 348
Author(s):  
Meena N. Satia ◽  
Shruti Panchbudhe ◽  
Manali P. Shilotri
Keyword(s):  
Health Care Systems ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Lower Segment Caesarean Section ◽  
Operative Removal ◽  
The World ◽  
Care Systems ◽  
Health Organization

Functioning of health systems with respect to maternal health were previously audited using indicators like maternal mortality ratio. However, maternal morbidity as a consequence of pregnancy-related complications is not accounted for in these indicators. Thus, the World Health Organization (WHO) has formulated a maternal near-miss approach to pregnancy complications for a more thorough evaluation of health care systems across the world. In practical terms, women are said to be maternal near-miss cases when they survive lethal conditions during pregnancy or in the postpartum period. We report one such case of traumatic variety of postpartum haemorrhage subsequent to a lower segment caesarean section with immediate post-operative removal of cervical cerclage threads that resulted in a maternal near-miss case.

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