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C-sections and hospital characteristics: a long term analysis on low-risk deliveries

Research output: Contribution to Journal/MagazineJournal articlepeer-review

E-pub ahead of print
<mark>Journal publication date</mark>14/12/2022
<mark>Journal</mark>Research in Health Services & Regions
Issue number1
Number of pages9
Publication StatusE-pub ahead of print
Early online date14/12/22
<mark>Original language</mark>English


Background: Policymakers aim to reduce C-section (CS) rates, due to well documented overtreatment. However, little is known about how hospital characteristics relate to their c-section rates on low-risk deliveries (CSR-LRD). Methods: CSR-LRD were computed using inpatient data from all Portuguese National Health Service hospitals (2002-2011). Linear and Fractional Response Models were estimated to quantify the relationship between CSR-LRD and a set of hospital characteristics: hospital size, type (exclusively obstetrics or not), Neonatal Intensive Care Unit (NICU) availability, obstetrician-to-obstetric bed ratio, and teaching status. Results: CSR-LRD increased from 11.7% (2002) to 14.1% (2008), declining to 12.5% in 2011. While larger hospitals and hospitals with NICU had higher CSR-LRD rates, teaching status and obstetrician-to-obstetric bed ratio had no significant effect. Adjusted estimates, controlling for those four characteristics, indicate 91% of the variation in the CSR-LRD is left unexplained. Conclusion: Hospital characteristics do not explain variation in CSR-LRD rates. Further studies considering medical practice, financial incentives to hospitals and/or physicians, and patient education are needed.