Development of a Framework for On-Demand Caesarean Section in Romania
Abstract
:1. Introduction
2. Materials and Methods
2.1. Target Population
2.2. Study Settings
2.3. The Romanian Context
2.4. Measurement and Valuation of Resources and Costs
2.5. Outcomes
2.6. Currency, Price Date, and Conversion
3. Results
3.1. Current Occupancy Rate of the Maternity Wards
3.2. Budget Impact Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Islam, M.A.; Sathi, N.J.; Hossain, M.T.; Jabbar, A.; Renzaho, A.M.N.; Islam, S.M.S. Caesarean Delivery and Its Association with Educational Attainment, Wealth Index, and Place of Residence in Sub-Saharan Africa: A Meta-Analysis. Sci. Rep. 2022, 12, 5554. [Google Scholar] [CrossRef] [PubMed]
- Volpe, F.M. Correlation of Cesarean Rates to Maternal and Infant Mortality Rates: An Ecologic Study of Official International Data. Rev. Panam. Salud Pública 2011, 29, 303–308. [Google Scholar] [CrossRef] [PubMed]
- Petrou, S.; Khan, K. An Overview of the Health Economic Implications of Elective Caesarean Section. Appl. Health Econ. Health Policy 2013, 11, 561–576. [Google Scholar] [CrossRef] [PubMed]
- Caesarean Section Rates Continue to Rise, Amid Growing Inequalities in Access. Available online: https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access (accessed on 11 November 2022).
- Large Differences in Share of Caesarean Births. Available online: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/ddn-20191217-1 (accessed on 11 November 2022).
- Hospital Cost of Vaginal Delivery in Select Countries in 2019. Statista. Available online: https://www.statista.com/statistics/312026/total-hospital-and-physician-costs-of-a-normal-delivery-by-country/ (accessed on 22 January 2023).
- Hospital Price for C-Section Delivery in Select Countries in 2019. Statista. Available online: https://www.statista.com/statistics/312028/cost-of-hospital-and-physician-for-a-c-section-delivery-by-country/ (accessed on 22 January 2023).
- Moran, P.S.; Normand, C.; Gillen, P.; Wuytack, F.; Turner, M.; Begley, C.; Daly, D. Economic Implications of Reducing Caesarean Section Rates—Analysis of Two Health Systems. PLoS ONE 2020, 15, e0228309. [Google Scholar] [CrossRef] [PubMed]
- Kotaska, A. Caesarean Section Or Vaginal Delivery in The 21st Century. Available online: https://www.euro.who.int/__data/assets/pdf_file/0006/277737/Cesarean-Section-or-Vaginal-Delivery-in-the-21st-Century.pdf (accessed on 11 November 2022).
- Gurol-Urganci, I.; Bou-Antoun, S.; Lim, C.P.; Cromwell, D.A.; Mahmood, T.A.; Templeton, A.; van der Meulen, J.H. Impact of Caesarean Section on Subsequent Fertility: A Systematic Review and Meta-Analysis. Hum. Reprod. 2013, 28, 1943–1952. [Google Scholar] [CrossRef] [PubMed]
- Cesarean Delivery on Maternal Request. Available online: https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2019/01/cesarean-delivery-on-maternal-request (accessed on 12 November 2022).
- Sorrentino, F.; Greco, F.; Palieri, T.; Vasciaveo, L.; Stabile, G.; Carlucci, S.; Laganà, A.S.; Nappi, L. Caesarean Section on Maternal Request-Ethical and Juridic Issues: A Narrative Review. Medicina 2022, 58, 1255. [Google Scholar] [CrossRef] [PubMed]
- D’Souza, R.; Arulkumaran, S. To ‘C’ or Not to ‘C’?/Caesarean Delivery upon Maternal Request: A Review of Facts, Figures and Guidelines. J. Perinat. Med. 2013, 41, 5–15. [Google Scholar] [CrossRef] [PubMed]
- Hoxha, I.; Syrogiannouli, L.; Luta, X.; Tal, K.; Goodman, D.C.; da Costa, B.R.; Jüni, P. Caesarean Sections and For-Profit Status of Hospitals: Systematic Review and Meta-Analysis. BMJ Open 2017, 7, e013670. [Google Scholar] [CrossRef] [PubMed]
- Romania Health System Information. Available online: https://eurohealthobservatory.who.int/countries/romania (accessed on 17 November 2022).
- Radu, C.-P.; Pana, B.C.; Pele, D.T.; Costea, R.V. Evolution of Public Health Expenditure Financed by the Romanian Social Health Insurance Scheme From 1999 to 2019. Front. Public Health 2021, 9, 795869. [Google Scholar] [CrossRef] [PubMed]
- Countries. Available online: https://eurohealthobservatory.who.int/monitors/health-systems-monitor/countries-hspm (accessed on 21 November 2022).
- Simionescu, A.A.; Marin, E. Caesarean Birth in Romania: Safe Motherhood Between Ethical, Medical and Statistical Arguments. Maedica 2017, 12, 5–12. [Google Scholar]
- Zeidenstein, L. Elective Cesarean Section: How Informed Is Informed? Online J. Health Ethics 2005, 2, 4. [Google Scholar] [CrossRef] [Green Version]
- Dubay, L.; Kaestner, R.; Waidmann, T. The Impact of Malpractice Fears on Cesarean Section Rates. J. Health Econ. 1999, 18, 491–522. [Google Scholar] [CrossRef] [PubMed]
- Johnson, E.; Rehavi, M.M. Physicians Treating Physicians: Information and Incentives in Childbirth; National Bureau of Economic Research: Cambridge, MA, USA, 2013; p. w19242. [Google Scholar] [CrossRef]
- Ilea, C.D.N.; Daina, L.G.; Bungau, S.; Tit, D.M.; Uivarosan, D.; Moleriu, L.; Petre, I.; Bungau, C.; Petre, I. Sustainable Management, Instable Legislation Regarding Wages, and Employee Satisfaction/Motivation in Two Romanian Hospitals. Sustainability 2020, 12, 909. [Google Scholar] [CrossRef] [Green Version]
Year | Natural Delivery Cases | C-Section Cases | Total Births | ||
---|---|---|---|---|---|
OGI | OGII | OGI | OGII | ||
2017 | 672 | 352 | 1117 | 467 | 2608 |
2018 | 700 | 358 | 1111 | 487 | 2656 |
2019 | 778 | 454 | 998 | 426 | 2656 |
2020 | 439 | 271 | 559 | 260 | 1529 |
Year | Ward | Effective Utilisation Rate | Difference up to: | |||||||
---|---|---|---|---|---|---|---|---|---|---|
85% | 80% | 75% | 70% | 65% | 60% | 55% | 50% | |||
2017 | OGI | 76.38% | 8.62 | 3.62 | - | - | - | - | - | - |
OGII | 46.51% | 38.49 | 33.49 | 28.49 | 23.49 | 18.49 | 13.49 | 8.49 | 3.49 | |
2018 | OGI | 74.79% | 10.21 | 5.21 | 0.21 | - | - | - | - | - |
OGII | 47.42% | 37.58 | 32.58 | 27.58 | 22.58 | 17.58 | 12.58 | 7.58 | 2.58 | |
2019 | OGI | 73.59% | 11.41 | 6.41 | 1.41 | - | - | - | - | - |
OGII | 47.93% | 37.07 | 32.07 | 27.07 | 22.07 | 17.07 | 12.07 | 7.07 | 2.07 |
Year | Ward | Patients Potentially Covered by Fee-For-Service Healthcare (No.) | |||||||
---|---|---|---|---|---|---|---|---|---|
85% | 80% | 75% | 70% | 65% | 60% | 55% | 50% | ||
2017 | OGI | 393 | 165 | ||||||
OGII | 1124 | 978 | 832 | 686 | 540 | 394 | 248 | 102 | |
2018 | OGI | 466 | 238 | 10 | |||||
OGII | 1097 | 951 | 805 | 659 | 513 | 367 | 221 | 75 | |
2019 | OGI | 521 | 292 | 64 | |||||
OGII | 1082 | 936 | 790 | 644 | 498 | 352 | 206 | 60 | |
Total | 4683 | 3561 | 2502 | 1990 | 1552 | 1114 | 676 | 238 |
Year | Ward | The Proposed Occupancy Rate | |||||||
---|---|---|---|---|---|---|---|---|---|
85% | 80% | 75% | 70% | 65% | 60% | 55% | 50% | ||
2017 | OGI | 773,620 | 324,885 | - | - | - | - | - | - |
OGII | 1,985,968 | 1,727,983 | 1,469,998 | 1,212,013 | 954,028 | 696,043 | 438,058 | 180,073 | |
Total | 2,759,588 | 2,052,868 | 1,469,998 | 1,212,013 | 954,028 | 696,043 | 438,058 | 180,073 | |
2018 | OGI | 916,318 | 467,582 | 18,847 | - | - | - | - | - |
OGII | 1,939,015 | 1,681,030 | 1,423,045 | 1,165,060 | 907,075 | 649,090 | 391,105 | 133,120 | |
Total | 2,855,333 | 2,148,612 | 1,441,892 | 1,165,060 | 907,075 | 649,090 | 391,105 | 133,120 | |
2019 | OGI | 1,024,015 | 575,279 | 126,543 | - | - | - | - | - |
OGII | 1,912,700 | 1,654,715 | 1,396,730 | 1,138,745 | 880,761 | 622,776 | 364,791 | 106,806 | |
Total | 2,936,715 | 2,229,994 | 1,523,273 | 1,138,745 | 880,761 | 622,776 | 364,791 | 106,806 | |
Total 2017–2019 | 8,551,636 | 6,431,474 | 4,435,163 | 3,515,818 | 2,741,864 | 1,967,909 | 1,193,954 | 419,999 |
Year | Ward | The Proposed Occupancy Rate | |||||||
---|---|---|---|---|---|---|---|---|---|
85% | 80% | 75% | 70% | 65% | 60% | 55% | 50% | ||
2017 | OGI | 156,854.1 | 6,5871.5 | ||||||
OGII | 402,661.7 | 350,354.4 | 298,047.1 | 245,739.7 | 193,432.4 | 141,125.1 | 88,817.7 | 36,510.4 | |
Total | 559,515.8 | 416,225.9 | 298,047.1 | 245,739.7 | 193,432.4 | 141,125.1 | 88,817.7 | 36,510.4 | |
2018 | OGI | 185,786.6 | 94,803.8 | 3821.3 | |||||
OGII | 393,141.9 | 340,834.5 | 288,527.2 | 236,219.9 | 183,912.5 | 131,605.2 | 79,297.9 | 26,990.5 | |
Total | 578,928.4 | 435,638.4 | 292,348.5 | 236,219.9 | 183,912.5 | 131,605.2 | 79,297.9 | 26,990.5 | |
2019 | OGI | 207,622.5 | 116,639.8 | 25,657.0 | |||||
OGII | 387,806.4 | 335,499.1 | 283,191.7 | 230,884.4 | 178,577.3 | 126,269.9 | 73,962.6 | 21,655.3 | |
Total | 595,428.9 | 452,138.8 | 308,848.8 | 230,884.4 | 178,577.3 | 126,269.9 | 73,962.6 | 21,655.3 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Petre, I.; Barna, F.; Cîtu, C.; Gorun, F.; Gorun, O.-M.; Tomescu, L.C.; Apostol, A.; Bordianu, A.; Furau, C.; Petre, I. Development of a Framework for On-Demand Caesarean Section in Romania. Int. J. Environ. Res. Public Health 2023, 20, 2705. https://doi.org/10.3390/ijerph20032705
Petre I, Barna F, Cîtu C, Gorun F, Gorun O-M, Tomescu LC, Apostol A, Bordianu A, Furau C, Petre I. Development of a Framework for On-Demand Caesarean Section in Romania. International Journal of Environmental Research and Public Health. 2023; 20(3):2705. https://doi.org/10.3390/ijerph20032705
Chicago/Turabian StylePetre, Ion, Flavia Barna, Cosmin Cîtu, Florin Gorun, Oana-Maria Gorun, Laurentiu Cezar Tomescu, Adrian Apostol, Anca Bordianu, Cristian Furau, and Izabella Petre. 2023. "Development of a Framework for On-Demand Caesarean Section in Romania" International Journal of Environmental Research and Public Health 20, no. 3: 2705. https://doi.org/10.3390/ijerph20032705