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Analysis
Medwave 2020;20(4):e7910 doi: 10.5867/medwave.2020.04.7910
A scoping review of the payment mechanisms in childbirth of country members and non-members of the Organisation for Economic Co-operation and Development
Karla Hernández-Sánchez, Daniela Hernández-Carrión, Daniela Paredes-Fernández
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Key Words: cesarean section, reimbursement mechanisms, insurance, health, reimbursement, OECD, parturition

Abstract

Introduction
Payment mechanisms serve to put into operation the function of purchasing in health. Payment mechanisms impact the decisions that healthcare providers make. Given this, we are interested in knowing how they affect the generalized increase of C-section rates globally.

Objective
The objective of this review is to describe existing payment mechanisms for childbirth in countries members of the Organization for Economic Co-operation and Development (OECD) and non-members.

Methods
We conducted a scoping review following the five methodological steps of the Joanna Briggs Institute. The search was conducted by researchers independently, achieving inter-reliability among raters (kappa index, 0.96). We searched electronic databases, grey literature, and governmental and non-governmental websites. We screened on three levels and included documents published in the last ten years, in English and Spanish. Results were analyzed considering the function of the reimbursement mechanism and its effects on providers, payers, and beneficiaries.

Results
Evidence from 34 countries was obtained (50% OECD members). Sixty-four percent of countries report the use of more than one payment mechanism for childbirth. Diagnosis-Related Groups (47.6%), Pay-for-performance (23.3%), Fee-for-service (16.6%) and Fixed-prospective systems (13.3%) are among the most frequently used mechanisms.

Conclusion
Countries use payment mechanism architecture to improve maternal-perinatal health indicators. Therefore, it is necessary to explore the best combination of mechanisms that improve the provision of health care and welfare of the population in the field of sexual and reproductive health.


 

The English version is in the process of being published.

Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

Introducción
Los mecanismos de pago corresponden a la operacionalización de la función de compra en salud, incentivando comportamientos en los proveedores de servicios sanitarios. Resulta pertinente preguntarse cómo afectan la vía de resolución del parto, considerando el aumento generalizado en índices de cesárea a nivel global.

Objetivo
Describir los mecanismos de pago existentes para la atención del parto en países miembros y no miembros de la Organización para la Cooperación y el Desarrollo Económico.

Métodos
Revisión sistemática exploratoria (scoping review). Se adoptaron los cinco pasos metodológicos del Joanna Briggs Institute. La búsqueda se realizó por las investigadoras de forma independiente, logrando la confiabilidad interevaluador (κ 0,96) en bases de datos electrónicas, otras fuentes de información, sitios web gubernamentales y no gubernamentales. Se tamizó en tres niveles, considerando literatura no mayor a 10 años de antigüedad, idioma inglés y español. Se analizaron los resultados considerando el funcionamiento del mecanismo de pago y sus efectos en prestadores, seguros y beneficiarias.

Resultados
Se obtuvo evidencia de 34 países (50% pertenecientes a la Organización para la Cooperación y el Desarrollo Económico). El 64% con uso de más de un mecanismo de pago para el parto. Entre los mecanismos más utilizados están: grupos relacionados de diagnósticos (47,6%), pago por resultados (23,3%), pago por servicios (16,6%) y pago fijo prospectivo (13,3%).

Conclusión
Los países recurren a la arquitectura de los mecanismos de pago para mejorar indicadores en salud materno-perinatales. Es necesario explorar cuál sería la mejor combinación de mecanismos que mejora la provisión de atenciones de salud y bienestar de la población, en el campo de la salud sexual y reproductiva.

Authors: Karla Hernández-Sánchez[1], Daniela Hernández-Carrión[2], Daniela Paredes-Fernández[3]

Affiliation:
[1] Lenz Consultores, Región Metropolitana, Santiago, Chile
[2] Escuela de Obstetricia y Puericultura, Facultad de Medicina, Universidad de Chile, Santiago, Chile
[3] Núcleo Académico Instituto de Salud Pública, Universidad Nacional Andrés Bello, Santiago, Chile

E-mail: dm_paredes@ug.uchile.cl

Author address:
[1] Fernández Concha 700
Las Condes, Santiago
Chile 7591538

Citation: Hernández-Sánchez K, Hernández-Carrión D, Paredes-Fernández D. A scoping review of the payment mechanisms in childbirth of country members and non-members of the Organisation for Economic Co-operation and Development. Medwave 2020;20(4):e7910 doi: 10.5867/medwave.2020.04.7910

Submission date: 17/10/2019

Acceptance date: 14/3/2020

Publication date: 27/5/2020

Origin: Not commissioned

Type of review: Externally peer-reviewed by three reviewers, double-blind

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  31. Janisch CP, Albrecht M, Wolfschuetz A, Kundu F, Klein S. Vouchers for health: A demand side output-based aid approach to reproductive health services in Kenya. Glob Public Health. 2010;5(6):578-94. | CrossRef | PubMed |
  32. Sidney K, Iyer V, Vora K, Mavalankar D, De Costa A. Statewide program to promote institutional delivery in Gujarat, India: who participates and the degree of financial subsidy provided by the Chiranjeevi Yojana program. J Health Popul Nutr. 2016 Jan 27;35:2. | CrossRef | PubMed |
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  40. Chaumont C, Muhorane C, Moreira-Burgos I, Juma N, Avila-Burgos L. Maternal and reproductive health financing in Burundi: public-sector contribution levels and trends from 2010 to 2012. BMC Health Serv Res. 2015 Oct 1;15:446. | CrossRef | PubMed |
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  42. Witter S, Dieng T, Mbengue D, Moreira I, De Brouwere V. The national free delivery and caesarean policy in Senegal: evaluating process and outcomes. Health Policy Plan. 2010 Sep;25(5):384-92. | CrossRef | PubMed |
  43. De Elejalde R, Giolito E. More Hospital Choices, More C-Sections: Evidence from Chile. IZA Institute of Labor Economics. 2019. [On lin | Link |
Kutzin J. A descriptive framework for country-level analysis of health care financing arrangements. Health Policy. 2001 Jun;56(3):171-204. | PubMed |

Buglioli M, Gianneo O, Mieres G. Modalidades de pago de la atención médica. Rev Méd Urug. 2002;18(3):198–210. [On line]. | Link |

Kutzin J. Towards universal health care coverage : goal-oriented framework for policy analysis. Report No: 28889. The World Bank; 2000: 1-57. [On line]. | Link |

World Health Organization. Health financing for universal coverage: Provider payment mechanisms. 2016. [On line]. | Link |

Jegers M, Kesteloot K, De Graeve D, Gilles W. A typology for provider payment systems in health care. Health Policy. 2002 Jun;60(3):255-73. | PubMed |

García-Lacalle J, Martín-Vallespín E, Royo-Montañés S. La financiación de la sanidad pública. Efecto de los sistemas de pago prospectivos en el rendimiento de los hospitales. Presup y Gasto Público. 2009;57:99–115.

Bellón Saameño JÁ. Demanda inducida por el profesional: aplicaciones de la teoría económica a la práctica clínica. Atención Primaria. 2006;38(5):293–8. | CrossRef |

Organización Mundial de la Salud. Declaración de la OMS sobre tasas de cesárea. 2015. [On line]. | Link |

Murray M. Childbirth in Santiago de Chile: stratification, intervention, and child centeredness. Med Anthropol Q. 2012 Sep;26(3):319-37. | PubMed |

Arksey H, O'Malley L. Scoping Studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32. [On line]. | Link |

The Joanna Briggs Institute. The Joanna Briggs Institute Reviewers' Manual 2015: Methodology for JBI Scoping Reviews. The Joanna Briggs Institute. 2015. [On line]. | Link |

Adams J, Steel A, Frawley J, Broom A, Sibbritt D. Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia. BMC Pregnancy Childbirth. 2017 Apr 12;17(1):114. | CrossRef | PubMed |

Hoxha I, Syrogiannouli L, Braha M, Goodman DC, da Costa BR, Jüni P. Caesarean sections and private insurance: systematic review and meta-analysis. BMJ Open. 2017 Aug 21;7(8):e016600. | CrossRef | PubMed |

Kim SJ, Han KT, Kim SJ, Park EC, Park HK. Impact of a diagnosis-related group payment system on cesarean section in Korea. Health Policy. 2016 Jun;120(6):596-603. | CrossRef | PubMed |

Bellanger MM, Quentin W, Tan SS. Childbirth and Diagnosis Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries. Eur J Obstet Gynecol Reprod Biol. 2013 May;168(1):12-9. | CrossRef | PubMed |

Mesterton J, Ladfors L, Ekenberg Abreu A, Lindgren P, Saltvedt S, Weichselbraun M, et al. Case mix adjusted variation in cesarean section rate in Sweden. Acta Obstet Gynecol Scand. 2017 May;96(5):597-606. | CrossRef | PubMed |

Calalieri M, Calogero G, Domenico L, Pignataro G. Financial Incentives and Inappropriateness in Health Care: Evidence from Italian Cesarean Sections. Finanz Public Financ Anal. 2014;70(3):430–57. [On line]. | Link |

Jarlenski M, Borrero S, La Charité T, Zite NB. Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy. Obstet Gynecol. 2016 Jun;127(6):1080-4. | CrossRef | PubMed |

Sonchak L. Medicaid reimbursement, prenatal care and infant health. J Health Econ. 2015 Dec;44:10-24. | CrossRef | PubMed |

Cunningham SD, Herrera C, Udo IE, Kozhimannil KB, Barrette E, Magriples U, et al. Maternal Medical Complexity: Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section. Womens Health Issues. 2017 Sep - Oct;27(5):551-558. | CrossRef | PubMed |

Catalyst for Payment Reform. Action Brief: Maternity Care Payment. 2020. [On line]. | Link |

Goic A. [The Chilean Health Care System: the task ahead]. Rev Med Chil. 2015 Jun;143(6):774-86. | CrossRef | PubMed |

Titelman D, Uthoff A. Ensayos sobre el financiamiento de la segurodad social en salud. Los casos de Estados Unidos - Canadá - Argentina - Chile - Colombia. 1a Ed. Santiago; CEPAL: 2000. [On line]. | Link |

Gobierno de Chile, Ministerio de Salud, Superintendencia de Salud. ¿FONASA o Isapre? Orientación en Salud. Santiago, Chile: Minsal; 2010. [On line]. | Link |

Gobierno de Chile, Ministerio de Salud, Superintendencia de Salud. Cobertura y Bonificaciones. Materias FONASA. Santiago, Chile: Minsal; 2020. [On line]. | Link |

FONASA. Tramos y Copagos. FONASA. 2020. [On line]. | Link |

FONASA. Programa PAD: Prestaciones: Parto. FONASA. 2020. [On line]. | Link |

FONASA. Programa PAD. FONASA. 2020. [On line]. | Link |

Sadler M, Leiva G, Perello A, Schorr J. Preferencia por vía de parto y razones de la operación cesárea en mujeres de la Región Metropolitana de Chile. Rev del Inst Salud Pública Chile. 2018;2(1):24–49. [On line]. | Link |

Bonfrer I, Van de Poel E, Van Doorslaer E. The effects of performance incentives on the utilization and quality of maternal and child care in Burundi. Soc Sci Med. 2014 Dec;123:96-104. | CrossRef | PubMed |

Janisch CP, Albrecht M, Wolfschuetz A, Kundu F, Klein S. Vouchers for health: A demand side output-based aid approach to reproductive health services in Kenya. Glob Public Health. 2010;5(6):578-94. | CrossRef | PubMed |

Sidney K, Iyer V, Vora K, Mavalankar D, De Costa A. Statewide program to promote institutional delivery in Gujarat, India: who participates and the degree of financial subsidy provided by the Chiranjeevi Yojana program. J Health Popul Nutr. 2016 Jan 27;35:2. | CrossRef | PubMed |

Hou X, Sabah Rakhshani N, Iunes R. Factors associated with high Cesarean deliveries in China and Brazil - A Call for reducing elective surgeries in moving towards universal health coverage. J Hosp Adm. 2014;3(5):67. | CrossRef |

Xiao S, Yan H, Shen Y, Dang S, Hemminki E, Wang D, et al. Utilization of delivery care among rural women in China: does the health insurance make a difference? a cross-sectional study. BMC Public Health. 2010 Nov 15;10:695. | CrossRef | PubMed |

Hong YC, Linn GC. Financial incentives and use of Cesarean delivery: Taiwan birth data 2003 to 2007. Am J Manag Care. 2012 Jan 1;18(1):e35-41. | PubMed |

Chen CS, Liu TC, Chen B, Lin CL. The failure of financial incentive? The seemingly inexorable rise of cesarean section. Soc Sci Med. 2014 Jan;101:47-51. | CrossRef | PubMed |

Lo JC. Financial incentives do not always work: an example of cesarean sections in Taiwan. Health Policy. 2008 Oct;88(1):121-9. | CrossRef | PubMed |

World Health Organization. Global Health Observatory data repository: Health service coverage: Data by country. 2020. [On line]. | Link |

Hoxha I, Syrogiannouli L, Luta X, Tal K, Goodman DC, da Costa BR, et al. Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis. BMJ Open. 2017 Feb 17;7(2):e013670. | CrossRef | PubMed |

Chaumont C, Muhorane C, Moreira-Burgos I, Juma N, Avila-Burgos L. Maternal and reproductive health financing in Burundi: public-sector contribution levels and trends from 2010 to 2012. BMC Health Serv Res. 2015 Oct 1;15:446. | CrossRef | PubMed |

Prinja S, Bahuguna P, Gupta R, Sharma A, Rana SK, Kumar R. Coverage and Financial Risk Protection for Institutional Delivery: How Universal Is Provision of Maternal Health Care in India? PLoS One. 2015 Sep 8;10(9):e0137315. | CrossRef | PubMed |

Witter S, Dieng T, Mbengue D, Moreira I, De Brouwere V. The national free delivery and caesarean policy in Senegal: evaluating process and outcomes. Health Policy Plan. 2010 Sep;25(5):384-92. | CrossRef | PubMed |

De Elejalde R, Giolito E. More Hospital Choices, More C-Sections: Evidence from Chile. IZA Institute of Labor Economics. 2019. [On lin | Link |