Why is the Rate of Cesarean Section in Urban China so High? Is the Price Transparency Policy Working?

Abstract

The caesarean section (CS) rate and non-clinically-indicated CS (NCS) rate in urban China are extremely high. On the demand side the assumed reason is China's one-child policy. We also assume that the supply side induces the CS demand, thus resulting in a continued rise in delivery expenditure. Therefore, so-called ‘price transparency policy’ was adopted to control costs. This study aims to prove that demand and supply factors may cause the high NCS rate, thus affecting the consequences of this policy, and causing a waste of resources and increased delivery expenditure. We conducted a multinomial logistic regression analysis to identify factors related to the high NCS rate, ANOVA and ANCOVA to compare the resource waste among the different delivery modes or hospitals. It was confirmed that the high NCS rate (37.7 per cent) in urban China might be predicted based not only on the demand factors (region of residence, parity, maternal age and weight gain), but also supply factors (hospital dummy). The price transparency policy requiring providers to disclose hospital charges information has thus led to inaccurate average CS charges, which confuse consumers, thus contributing to the overuse of NCS. Our study indicates that this policy could not effectively control costs.

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