Hospital Variation in Cesarean Delivery: A Multilevel Analysis

Andres I. Vecino-Ortiz, David Bardey, Ramon Castano-Yepes

Research output: Contribution to journalArticle

Abstract

Objectives: To assess the issue of hospital variations in Colombia and to contribute to the methodology on health care variations by using a model that clusters the variance between hospitals while accounting for individual-level reimbursement rates and objective health-status variables. Methods: We used data on all births (N = 11,954) taking place in a contributory-regimen insurer network in Colombia during 2007. A multilevel logistic regression model was used to account for the share of unexplained variance between hospitals. In addition, an alternative variance decomposition specification was further carried out to measure the proportion of such unexplained variance due to the region effect. Results: Hospitals account for 20% of the variation in performing cesarean sections, whereas region explains only one-third of such variance. Variables accounting for preferences on the demand side as well as reimbursement rates are found to predict the probability of performing cesarean sections. Conclusions: Hospital variations explain large variances within a single-payer's network. Because this insurer company is highly regarded in terms of performance and finance, these results might provide a lower bound for the scale of hospital variation in the Colombian health care market. Such lower bound provides guidance on the relevance of this issue for Colombia. Some factors such as demand-side preferences and physician reimbursement rates increase variations in health care even within a single-payer network. This is a source of inefficiencies, threatening the quality of health care and financial sustainability. The proposed methodology should be considered in further research on health care variations.

Original languageEnglish (US)
Pages (from-to)116-121
Number of pages6
JournalValue in Health Regional Issues
Volume8
DOIs
StatePublished - Dec 1 2015

Fingerprint

Multilevel Analysis
Colombia
Insurance Carriers
Cesarean Section
Logistic Models
Delivery of Health Care
Health Care Sector
Quality of Health Care
Health Services Research
Health Status
Multilevel analysis
Parturition
Physicians
Healthcare

Keywords

  • Birth procedure
  • Cesarean section
  • Hospital variation
  • Multilevel analysis
  • Small-area variation

ASJC Scopus subject areas

  • Economics, Econometrics and Finance (miscellaneous)
  • Pharmacology, Toxicology and Pharmaceutics (miscellaneous)
  • Health Policy

Cite this

Hospital Variation in Cesarean Delivery : A Multilevel Analysis. / Vecino-Ortiz, Andres I.; Bardey, David; Castano-Yepes, Ramon.

In: Value in Health Regional Issues, Vol. 8, 01.12.2015, p. 116-121.

Research output: Contribution to journalArticle

Vecino-Ortiz, Andres I. ; Bardey, David ; Castano-Yepes, Ramon. / Hospital Variation in Cesarean Delivery : A Multilevel Analysis. In: Value in Health Regional Issues. 2015 ; Vol. 8. pp. 116-121.
@article{c9074b796d37463e8e76bcb7d85248d8,
title = "Hospital Variation in Cesarean Delivery: A Multilevel Analysis",
abstract = "Objectives: To assess the issue of hospital variations in Colombia and to contribute to the methodology on health care variations by using a model that clusters the variance between hospitals while accounting for individual-level reimbursement rates and objective health-status variables. Methods: We used data on all births (N = 11,954) taking place in a contributory-regimen insurer network in Colombia during 2007. A multilevel logistic regression model was used to account for the share of unexplained variance between hospitals. In addition, an alternative variance decomposition specification was further carried out to measure the proportion of such unexplained variance due to the region effect. Results: Hospitals account for 20{\%} of the variation in performing cesarean sections, whereas region explains only one-third of such variance. Variables accounting for preferences on the demand side as well as reimbursement rates are found to predict the probability of performing cesarean sections. Conclusions: Hospital variations explain large variances within a single-payer's network. Because this insurer company is highly regarded in terms of performance and finance, these results might provide a lower bound for the scale of hospital variation in the Colombian health care market. Such lower bound provides guidance on the relevance of this issue for Colombia. Some factors such as demand-side preferences and physician reimbursement rates increase variations in health care even within a single-payer network. This is a source of inefficiencies, threatening the quality of health care and financial sustainability. The proposed methodology should be considered in further research on health care variations.",
keywords = "Birth procedure, Cesarean section, Hospital variation, Multilevel analysis, Small-area variation",
author = "Vecino-Ortiz, {Andres I.} and David Bardey and Ramon Castano-Yepes",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.vhri.2015.07.003",
language = "English (US)",
volume = "8",
pages = "116--121",
journal = "Value in Health Regional Issues",
issn = "2212-1099",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Hospital Variation in Cesarean Delivery

T2 - A Multilevel Analysis

AU - Vecino-Ortiz, Andres I.

AU - Bardey, David

AU - Castano-Yepes, Ramon

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objectives: To assess the issue of hospital variations in Colombia and to contribute to the methodology on health care variations by using a model that clusters the variance between hospitals while accounting for individual-level reimbursement rates and objective health-status variables. Methods: We used data on all births (N = 11,954) taking place in a contributory-regimen insurer network in Colombia during 2007. A multilevel logistic regression model was used to account for the share of unexplained variance between hospitals. In addition, an alternative variance decomposition specification was further carried out to measure the proportion of such unexplained variance due to the region effect. Results: Hospitals account for 20% of the variation in performing cesarean sections, whereas region explains only one-third of such variance. Variables accounting for preferences on the demand side as well as reimbursement rates are found to predict the probability of performing cesarean sections. Conclusions: Hospital variations explain large variances within a single-payer's network. Because this insurer company is highly regarded in terms of performance and finance, these results might provide a lower bound for the scale of hospital variation in the Colombian health care market. Such lower bound provides guidance on the relevance of this issue for Colombia. Some factors such as demand-side preferences and physician reimbursement rates increase variations in health care even within a single-payer network. This is a source of inefficiencies, threatening the quality of health care and financial sustainability. The proposed methodology should be considered in further research on health care variations.

AB - Objectives: To assess the issue of hospital variations in Colombia and to contribute to the methodology on health care variations by using a model that clusters the variance between hospitals while accounting for individual-level reimbursement rates and objective health-status variables. Methods: We used data on all births (N = 11,954) taking place in a contributory-regimen insurer network in Colombia during 2007. A multilevel logistic regression model was used to account for the share of unexplained variance between hospitals. In addition, an alternative variance decomposition specification was further carried out to measure the proportion of such unexplained variance due to the region effect. Results: Hospitals account for 20% of the variation in performing cesarean sections, whereas region explains only one-third of such variance. Variables accounting for preferences on the demand side as well as reimbursement rates are found to predict the probability of performing cesarean sections. Conclusions: Hospital variations explain large variances within a single-payer's network. Because this insurer company is highly regarded in terms of performance and finance, these results might provide a lower bound for the scale of hospital variation in the Colombian health care market. Such lower bound provides guidance on the relevance of this issue for Colombia. Some factors such as demand-side preferences and physician reimbursement rates increase variations in health care even within a single-payer network. This is a source of inefficiencies, threatening the quality of health care and financial sustainability. The proposed methodology should be considered in further research on health care variations.

KW - Birth procedure

KW - Cesarean section

KW - Hospital variation

KW - Multilevel analysis

KW - Small-area variation

UR - http://www.scopus.com/inward/record.url?scp=84946545801&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84946545801&partnerID=8YFLogxK

U2 - 10.1016/j.vhri.2015.07.003

DO - 10.1016/j.vhri.2015.07.003

M3 - Article

AN - SCOPUS:84946545801

VL - 8

SP - 116

EP - 121

JO - Value in Health Regional Issues

JF - Value in Health Regional Issues

SN - 2212-1099

ER -