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Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis

OBJECTIVE: Financial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS. DESIGN: Systematic review and meta-analysis. DATA SOURCES: ME...

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Autores principales: Hoxha, Ilir, Syrogiannouli, Lamprini, Luta, Xhyljeta, Tal, Kali, Goodman, David C, da Costa, Bruno R, Jüni, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318567/
https://www.ncbi.nlm.nih.gov/pubmed/28213600
http://dx.doi.org/10.1136/bmjopen-2016-013670
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author Hoxha, Ilir
Syrogiannouli, Lamprini
Luta, Xhyljeta
Tal, Kali
Goodman, David C
da Costa, Bruno R
Jüni, Peter
author_facet Hoxha, Ilir
Syrogiannouli, Lamprini
Luta, Xhyljeta
Tal, Kali
Goodman, David C
da Costa, Bruno R
Jüni, Peter
author_sort Hoxha, Ilir
collection PubMed
description OBJECTIVE: Financial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the first year of records through February 2016. ELIGIBILITY CRITERIA: To be eligible, studies had to report data to allow the calculation of ORs of CS comparing private for-profit hospitals with public or private non-profit hospitals in a specific geographic area. OUTCOMES: The prespecified primary outcome was the adjusted OR of births delivered by CS in private for-profit hospitals as compared with public or private non-profit hospitals; the prespecified secondary outcome was the crude OR of CS in private for-profit hospitals as compared with public or private non-profit hospitals. RESULTS: 15 articles describing 17 separate studies in 4.1 million women were included. In a meta-analysis of 11 studies, the adjusted odds of delivery by CS was 1.41 higher in for-profit hospitals as compared with non-profit hospitals (95% CI 1.24 to 1.60) with no relevant heterogeneity between studies (τ(2)≤0.037). Findings were robust across subgroups of studies in stratified analyses. The meta-analysis of crude estimates from 16 studies revealed a somewhat more pronounced association (pooled OR 1.84, 95% CI 1.49 to 2.27) with moderate-to-high heterogeneity between studies (τ(2)≥0.179). CONCLUSIONS: CS are more likely to be performed by for-profit hospitals as compared with non-profit hospitals. This holds true regardless of women's risk and contextual factors such as country, year or study design. Since financial incentives are likely to play an important role, we recommend examination of incentive structures of for-profit hospitals to identify strategies that encourage appropriate provision of CS.
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spelling pubmed-53185672017-02-27 Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis Hoxha, Ilir Syrogiannouli, Lamprini Luta, Xhyljeta Tal, Kali Goodman, David C da Costa, Bruno R Jüni, Peter BMJ Open Health Services Research OBJECTIVE: Financial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the first year of records through February 2016. ELIGIBILITY CRITERIA: To be eligible, studies had to report data to allow the calculation of ORs of CS comparing private for-profit hospitals with public or private non-profit hospitals in a specific geographic area. OUTCOMES: The prespecified primary outcome was the adjusted OR of births delivered by CS in private for-profit hospitals as compared with public or private non-profit hospitals; the prespecified secondary outcome was the crude OR of CS in private for-profit hospitals as compared with public or private non-profit hospitals. RESULTS: 15 articles describing 17 separate studies in 4.1 million women were included. In a meta-analysis of 11 studies, the adjusted odds of delivery by CS was 1.41 higher in for-profit hospitals as compared with non-profit hospitals (95% CI 1.24 to 1.60) with no relevant heterogeneity between studies (τ(2)≤0.037). Findings were robust across subgroups of studies in stratified analyses. The meta-analysis of crude estimates from 16 studies revealed a somewhat more pronounced association (pooled OR 1.84, 95% CI 1.49 to 2.27) with moderate-to-high heterogeneity between studies (τ(2)≥0.179). CONCLUSIONS: CS are more likely to be performed by for-profit hospitals as compared with non-profit hospitals. This holds true regardless of women's risk and contextual factors such as country, year or study design. Since financial incentives are likely to play an important role, we recommend examination of incentive structures of for-profit hospitals to identify strategies that encourage appropriate provision of CS. BMJ Publishing Group 2017-02-17 /pmc/articles/PMC5318567/ /pubmed/28213600 http://dx.doi.org/10.1136/bmjopen-2016-013670 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Health Services Research
Hoxha, Ilir
Syrogiannouli, Lamprini
Luta, Xhyljeta
Tal, Kali
Goodman, David C
da Costa, Bruno R
Jüni, Peter
Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis
title Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis
title_full Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis
title_fullStr Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis
title_full_unstemmed Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis
title_short Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis
title_sort caesarean sections and for-profit status of hospitals: systematic review and meta-analysis
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318567/
https://www.ncbi.nlm.nih.gov/pubmed/28213600
http://dx.doi.org/10.1136/bmjopen-2016-013670
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