Cesarean section deliveries in one health insurance hospital in Alexandria

Cesarean section [CS] rates have been increasing world wide, raising the question of the appropriateness of the selection of cases for the procedure. The World Health Organization [WHO] states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. The aim of the work was to determine the trend of cesarean section deliveries in Gamal Abdel Naser Hospital which is affiliated to the Health Insurance Organization [HIO]. The study was conducted through a descriptive retrospective approach. The study sample included the a] recorded deliveries between 1998-2005 [n=15917] for estimating the trend of cesarean section deliveries, and b] the medical records of CS deliveries at 2002 in the hospital [n=837] for identifying the indications of CS and their adequacy as a source of information for evaluation of CS deliveries. The study revealed that; cesarean section rate was high and increasing during the period from 1998 - 2005.The highest percent was in the year 2004 [57.9%]. The trend of increase was significant [c for linear trend = 162.717, p = 0.000].Thursdays accounted for the highest percent of both admissions and deliveries, while Fridays accounted for the lowest percent. More than one half of deliveries occurred between 2 pm to before 8 pm. More than three quarters of the study sample [77.9%] did not have trial labour. Only 12.8% of the total study sample had induction and the outcome of induction was dystocia in 85%.The main indication of cesarean section was previous CS [41.2%], fetal distress [17.6%], failed trial and failure to progress [11.4%], cephalo-pelvic disproportion [10.3%], abnormal presentation [5.6%] and ante-partum hemorrhage [3.2%]. Patient's records lack most of the essential information so it was not possible to verify recorded indication to justify caesarean section

Use of out-of-plan services by health insurance beneficiaries in Alexandria

This study examined the services obtained by the Health Insurance beneficiaries from non-health insurance physicians. Obtaining health services by Health Insurance beneficiaries from non-health insurance physicians was also examined in the present work. The study was conducted at three Health Insurance Organization [HIO] clinics in Alexandria. A pre-coded interview questionnaire was used to gather the required information from 610 randomly selected beneficiaries. The study revealed a high pattern of out-of-plan use by HIO beneficiaries, 66.6% utilized at least one out-of-plan per year. The beneficiary characteristics that are associated with the out-of-plan use were quality rating of services, perceived health status, seeking second opinion, education and the number of chronic diseases. The mean out of pocket expenditure at the last out-of-plan visit was LE 100. The implications for the Health Insurance Organization and financing of health services were discussed