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Changes in cesarean section rates after introduction of a punitive financial policy in Georgia: A population-based registry study 2017–2019

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  • Ingvild Hersoug Nedberg
  • Tinatin Manjavidze
  • Charlotta Rylander
  • Ellen Blix
  • Finn Egil Skjeldestad
  • Erik Eik Anda

Abstract

Background: There is little research on how financial incentives and penalties impact national cesarean section rates. In January 2018, Georgia introduced a national cesarean section reduction policy, which imposes a financial penalty on hospitals that do not meet their reduction targets. The aim of this study was to assess the impact of this policy on cesarean section rates, subgroups of women, and selected perinatal outcomes. Methods: We included women who gave birth from 2017 to 2019 registered in the Georgian Birth Registry (n = 150 534, nearly 100% of all births in the country during this time). We then divided the time period into pre-policy (January 1, 2017, to December 31, 2017) and post-policy (January 1, 2018, to December 31, 2019). An interrupted time series analysis was used to compare the cesarean section rates (both overall and stratified by parity), neonatal intensive care unit transfer rates, and perinatal mortality rates in the two time periods. Descriptive statistics were used to assess differences in maternal socio-demographic characteristics. Results: The mean cesarean section rate in Georgia decreased from 44.7% in the pre-policy period to 40.8% in the post-policy period, mainly among primiparous women. The largest decrease in cesarean section births was found among women

Suggested Citation

  • Ingvild Hersoug Nedberg & Tinatin Manjavidze & Charlotta Rylander & Ellen Blix & Finn Egil Skjeldestad & Erik Eik Anda, 2022. "Changes in cesarean section rates after introduction of a punitive financial policy in Georgia: A population-based registry study 2017–2019," PLOS ONE, Public Library of Science, vol. 17(7), pages 1-13, July.
    • Handle: RePEc:plo:pone00:0271491
    DOI: 10.1371/journal.pone.0271491
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    References listed on IDEAS

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    1. Yushan Yu & Xiangyang Zhang & Caixia Sun & Huijie Zhou & Qi Zhang & Chun Chen, 2017. "Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou, China," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-12, November.
    2. Chen, Chin-Shyan & Liu, Tsai-Ching & Chen, Bradley & Lin, Chung-Liang, 2014. "The failure of financial incentive? The seemingly inexorable rise of cesarean section," Social Science & Medicine, Elsevier, vol. 101(C), pages 47-51.
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