Caesarean Sections in Beijing, China - Results from a Descriptive Study

Objective: Caesarean section rates are increasing dramatically in China. The predominant contributor to the increase in China was the unnecessary Caesarean section. The objective of this study was to estimate the excess economic burden caused by unnecessary Caesarean sections vs. vaginal delivery for Beijing and all China. Methods: The 33 476 obstetric medical case files from randomly selected 17 hospitals of Beijing in 2011 were taken for our descriptive approach. Based on the individual medical files and on a definition of what necessary and unnecessary Caesarean sections are, we sampled also the data for costs and length of stay for comparisons with vaginal deliveries. The Mann-Whitney U test and Pearson chi-square test statistics were used to test for significant difference in the analysis. Results: The Caesarean section rate was 58.5% among all deliveries and that rate of unnecessary Caesarean sections was 71.5% among all the Caesarean sections but 41.8% among all deliveries in Beijing. The hospitalisation expenses of unnecessary Caesarean sections were 472 US$ higher than that of a vaginal delivery on average. The total excess economic burden caused by unnecessary Caesarean sections can be estimated to 38.97 million US$ for Beijing and to 3.29 billion US$ all over China in 2011. This is equivalent to the annual health expenditure of over 139 575 residents in Beijing and of 11 783 120 residents in China, respectively. Conclusion: Socio-economic factors are possible reasons for the increase of unnecessary Caesarean section in China and more analytical attention should be paid to that problem in order to propose fitting practical reactions.