10 facts from the Council of Medical Schemes report on C-sections in SA

The Council for Medical Schemes (CMS) has called for urgent steps to be taken to reduce high levels of medically unnecessary caesarean births in the medical schemes population in South Africa. This is after their report, which had data collected between 2018 and 2019, found that our medical schemes industry overall caesarean section (CS) rate was 77.4% – amongst highest in the world.

The report also found the following with regards to caesarean sections in SA:

• On average, patients are likely to pay R42,440.77 for a CS delivery in the private sector.
• Fees charged by specialists assisting with both CS and natural delivery birth have been increasing at an above-inflation annual rate of 8.6% and 8.8%.
• The average cost of specialists for a CS delivery (R9,565.46 ± R260.00) was found to be significantly higher than the costs associated with natural birth delivery (R5,041.02 ± R136.45).
• Most caesarean births are likely to be elective amongst patients on medical aids.
• The rate of caesarean births has remained high in the population covered by medical schemes, even though they are not a chronic condition benefit.
• The odds of a CS delivery were reduced in comprehensive plans compared to hospital plans, even when the proportion of births is high across all plan types.
• Of the nearly 15% of pregnant women who experience obstetric complications during their pregnancy, CS delivery will be a life-saving intervention for between 3.6% and 6.5% of cases.
• C-section births continue to increase despite the known associated adverse health outcomes such as the risk of infection, surgical and anaesthetic complications, reduced likelihood of breastfeeding, and risks for the baby.
• Fear of litigation was found to be one of the factors associated with the increased rates of CS births. Possibility of reforms in the medical malpractice regime must be investigated
• Alternative mechanisms to finance maternity care in the population covered by medical schemes to drive appropriate incentives must be investigated. A high reimbursement rate for CS deliveries is a likely driver for the very high prevalence of CS in the medical schemes population.

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