Abstract
BackgroundThis paper examines two state-led public–private demand-side financial support programs aiming to raise hospital delivery rates in two neighbouring Indian states—Gujarat and Madhya Pradesh. The national Janani Suraksha Yojana (JSY) was complemented with a public–private partnership program Janani Sahayogi Yojana (JSaY) in Madhya Pradesh in which private obstetricians were paid to deliver poor women. A higher amount was paid for caesarean sections (CS) than for vaginal deliveries (VD). In Gujarat state, the state program Chiranjeevi Yojana (CY) paid private obstetricians a fixed amount for a block 100 deliveries irrespective of delivery mode. The two systems thus offered an opportunity to observe the influence of supplier-induced demand (SID) from opposite incentives related to delivery mode.MethodsThe data from the two programs was sourced from the Departments of Health and Family Welfare, Governments of Gujarat and Madhya Pradesh, India.ResultsIn JSaY program the CS rate increased from 26.6 % (2007–2008) to 40.7 % (2010–2011), against the background rate for CS in Madhya Pradesh, of only 4.9 % (2004–2006). Meanwhile in CY program in Gujarat, the CS rate decreased to 4.3 % (2010–2011) against a background CS rate of 8.1 % (2004–2006).ConclusionsThe findings from India are unique in that they not only point to a significant impact from the introduction of the financial incentives but also how disincentives have an inverse impact on the choice of delivery method.
Highlights
Medical ethics assume that interventions and procedures are decided purely on the basis of clinical evidence and expected beneficial outcomes for the patient, and certainly not by provider financial considerations
In Janani Sahayogi Yojana (JSaY) program the caesarean sections (CS) rate increased from 26.6 % (2007–2008) to 40.7 % (2010–2011), against the background rate for CS in Madhya Pradesh, of only 4.9 % (2004–2006)
We report here on how the CS rates among program beneficiaries in private hospitals participating in the two different programs have changed in opposite directions after the programs, with provider financial incentives working in opposite directions, were introduced
Summary
Medical ethics assume that interventions and procedures are decided purely on the basis of clinical evidence and expected beneficial outcomes for the patient, and certainly not by provider financial considerations. Anecdotal evidence exists to support the belief that SID is not uncommon in the health sector and that it may have considerable influence on the quantity and contents of health services. This influence has, been difficult to demonstrate with empirical evidence since there are typically many potential confounders which are uncontrollable in observational studies [3]. This paper examines two state-led public– private demand-side financial support programs aiming to raise hospital delivery rates in two neighbouring Indian states—Gujarat and Madhya Pradesh. The two systems offered an opportunity to observe the influence of supplier-induced demand (SID) from opposite incentives related to delivery mode
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