The Council for Medical Schemes (CMS) said urgent steps must be taken to reduce high levels of medically unnecessary caesarean births in the medical schemes population.
A newly released report by the council claims the overall caesarean section (CS) rate for the medical schemes industry was 77.4%, which is among the highest in the world.
According to the report the rate of caesarean births, most of which are likely to be elective, has remained high in the population covered by medical schemes, even though they are not a chronic condition benefit.
“It is estimated nearly 15% of pregnant women will experience obstetric complications during their pregnancy, and CS delivery will be a life-saving intervention for between 3.6% and 6.5% of cases.
“C-section births continue to increase despite the known associated adverse health outcomes. These include increased risk of infection, surgical and anaesthetic complications, reduced likelihood of breastfeeding, and risks for the baby,” reads the report.
The epidemiology and trends of CS births in the medical schemes’ population were done between 2015 and 2018.
On average, patients part with R42,440.77 for a CS delivery in the private sector.
The report also found that fees charged by specialists assisting with both CS and natural delivery birth have been increasing at an above-inflation annual rate of 8.6% and 8.8%, respectively.
“Due to involvement of a greater number of specialists in the CS delivery, the average cost of specialists for a CS delivery (R9,565.46 ± R260.00) were found to be significantly higher than the costs associated with natural birth delivery (R5,041.02 ± R136.45).
“Professional fees for CS accounted for 25.4% of the total average birth admission cost compared to 23.4% for natural birth delivery,” said the report.
The odds of a CS delivery were reduced in comprehensive plans compared to hospital plans, even when the proportion of births is high across all plan types.
“Age, income, and education are other patient-related factors that are known to be associated with the preference of CS delivery.”
The report said this does not include the medical malpractice factor.
“The fear of litigation has been implicated as one of the factors associated with the increased rates of CS births. Possibility of reforms in the medical malpractice regime must be investigated.
“Alternative mechanisms to finance maternity care in the population covered by medical schemes to drive appropriate incentives must be investigated. A high reimbursement rate for CS deliveries is a likely driver for the very high prevalence of CS in the medical schemes population,” said the report.