Factors Related to the High Cesarean Section Rate and Their Effects on the "Price Transparency Policy" in Beijing, China

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Abstract
In urban China, many non-clinically indicated cesarean sections (NCSs) are performed, resulting in an unnaturally high cesarean section (CS) rate. NCSs represent CSs without any specific medical indications. The demand for NCS may be due to women's preference for CS and their belief in its safety and comfortableness. In addition, CS is more profitable for the supply side than vaginal delivery, which results in a continued rise in delivery expenditures. As a result, the so-called "price transparency policy", which forces hospitals to declare their average hospital charges, was adopted to control the delivery expenditures in the ongoing Chinese healthcare reform policy. The purpose of this study is to prove that the supply and demand factors affect the choice of delivery modes and more resources are consumed in NCS. The data of 680 live deliveries were collected from three hospitals in Beijing. Multinomial logistic regression analyses were conducted to identify the factors related to choosing NCS, and ANOVA and ANCOVA were used to compare the charges, proxy for resource utilization, among the delivery modes or hospitals. The results showed that the high NCS rate (37.7%) might be predicted not only based on the demand factors (region of residence, parity, maternal age and weight gain) but also on the supply factors (hospital dummy, revenue-staff ratio, bed turnover rate and obstetric medical staffs-delivery ratio), suggesting that such induced NCSs result in an unnecessarily high resource consumption. These data suggest that the present Chinese policy fails to control delivery expenditures.