Caesarean section in uninsured women in the USA: systematic review and meta-analysis.
caesarean section
health insurance
medical practice variation
self-pay
underuse
uninsured
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
03 03 2019
03 03 2019
Historique:
entrez:
6
3
2019
pubmed:
6
3
2019
medline:
24
3
2020
Statut:
epublish
Résumé
The aim of this study is to assess the odds of caesarean section (CS) for uninsured women in the USA and understand the underlying mechanisms as well as consequences of lower use. Systematic review and meta-analysis. PubMed, Embase, the Cochrane Library and CINAHL from the first year of records to April 2018. We included studies that reported data to allow the calculation of ORs of CS of uninsured as compared with insured women. The prespecified primary outcome was the adjusted OR of deliveries by CS of uninsured women as compared with privately or publicly insured women. The prespecified secondary outcome was the crude OR of deliveries by CS of uninsured women as compared with insured women. 12 articles describing 16 separate studies involving more than 8.8 million women were included in this study. We found: 0.70 times lower odds of CS in uninsured as compared with privately insured women (95% CI 0.63 to 0.78), with no relevant heterogeneity between studies (τ CSs are less likely to be performed in uninsured women as compared with insured women. While the higher rates for CS among privately insured women can be explained with financial incentives associated with private insurance, the lower odds among uninsured women draw attention at barriers to access for delivery care. In many regions, the rates for uninsured women are above, close or below the benchmarks for appropriate CS rates and could imply both, underuse and overuse.
Identifiants
pubmed: 30833323
pii: bmjopen-2018-025356
doi: 10.1136/bmjopen-2018-025356
pmc: PMC6443081
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e025356Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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