C-section delivery spike shakes Kenyan insurers

The unprecedented rise in the number of Kenyan women opting for caesarean sections across the country has left insurance companies with huge medical claims to settle as the share of vaginal births declines.

Multiple interviews with medical insurance companies, including Jubilee, AAR Insurance, and Britam, revealed that caesarean deliveries, commonly referred to as CS, account for nearly 70 percent of maternity bills.

For example, of the Sh1.67 billion paid by Jubilee Health, one of Kenya’s largest health insurers, for deliveries in the past five years, about 67 percent, or Sh1.11 billion, was allocated to caesarean sections.

During this period, Jubilee saw the proportion of caesarean sections in total deliveries that used her medical card rise from 42 percent to 58 percent.

While insurance agents are concerned about this trend, they are often careful not to be seen as standing in the way of women who view C-sections as safer than regular deliveries or for a lower social class.

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“While there are emergencies that require a caesarean section, there are many women who now say they are too fine to pay. Therefore, a normal delivery is almost seen as something for the poor or for the They don’t have medical insurance.”

“The moment one walks into the hospital with a medical card, they are almost seen as holding an open check. How much this affects whether it will be a cesarean or our bills lie in pain.”

The latest data from the Kenya National Bureau of Statistics (KNBS) shows that births through C-section have nearly doubled in the past eight years, from nine percent in 2014 to 17 percent in 2022.

Of the 1.24 million hospital births in Kenya last year, 211,227 were by C-section compared to 110,900 in 2014 when the total number of hospital births was 895,400.

Hospitals such as MP Shah, Aga Khan Hospital, Nairobi Hospital and Mater Hospital were last year charging upwards of Sh210,000 for a caesarean section, with emergency C-sections topping Sh300,000.

Normal deliveries range between Sh80,000 and Sh100,000 in the same hospitals. Costs were rising in line with inflation.

The World Health Organization (WHO) warned in a 2018 guidance note that “the continuing and unprecedented rise in caesarean section rates is a major public health concern.”

The World Health Organization has said that the ideal rate for caesarean section should be between 10 percent and 15 percent and that unnecessary procedures do not bring any proven advantage.

It also concluded in 2015 that caesarean section rates of greater than 10 percent were not associated with reduced maternal and newborn mortality rates.

The World Health Organization said: “There is no evidence to show the benefits of caesarean section for women or infants who do not need this procedure.”

For Kenya, the percentage of caesarean sections is twice as high in urban areas (23.8 percent) than in rural areas (12.3 percent), according to KNBS data.

Health facilities run by religious organizations and the private medical sector (excluding those belonging to non-governmental organizations) had 28.2 percent and 27.8 percent of their live births, respectively, by caesarean section.

This is nearly twice as high as 15 per cent in public sector health facilities.

About 15-20 percent of inpatient cases among women under medical coverage for AAR are related to maternity, so more C-section births mean higher claims, said Dr. Patrick Gatunga, CEO of AAR Insurance Group.

“If you factor in the price difference where C-section fees are sometimes two or three times the cost of normal deliveries, the cost impact is enormous. It is one of the biggest cost drivers for health insurance claims,” said Dr. Gatunga.

“C-section is such an impact on outcomes because if it is abused, it is not unusual to end in complications, including long-term complications that ultimately lead to an increase in claims for Medicare coverage.”

Births by caesarean section in 19 counties are now above the expected upper limit of 15 per cent compared to 2014 when the share of C-section in total births was surpassed by only five counties – Kirinyaga, Embu, Taraka Nithi, Kiambu and Nairobi. 15 percent.

Kirinyaga has the highest rate of caesarean section (40 per cent) followed by Kyambu (33 per cent), Tharaka Nithi (30 per cent), Nairobi (28 per cent), and Taita/Taveta (27 per cent).

The provinces with the lowest caesarean section rates are Wajir (two percent), Mandera (four percent), Turkana (four percent), and Samburu (five percent).

“The demand generated by the supply of C-sections has had a negative impact on medical insurance profitability primarily because of the increased cost of care and the premium charge applicable to such use,” said Jackson Theory, chief executive officer of Pritam General. insurance.

The KNBS survey found that 84 percent of women who delivered by caesarean section stayed at a health facility for three days or more compared to 14 percent of women who delivered vaginally.

Longer hospital stays usually translate to higher medical bills.

Behind these bundles of joy being delivered through a C-section was the silent pain of insurance companies and doctors who insist that they simply prioritize their patients’ lives, said Nizar Juma, president of Jubilee Insurance.

We can attribute this to doctors convincing their patients to have a C-section because they get up to four times as much money. Mr. Jumaa said: “For patients, whatever the doctor says is like the word of God.

Doctors tell their patients that they can set the day and time of birth, that they will not feel pain and can choose a birthday of their choice. I doubt they tell them anything about the potential risks that come with a C-section.”

A caesarean section can be necessary in situations such as prolonged or obstructed labour, fetal distress, or because the baby appears in an abnormal position.

But for all its advantages, policymakers like the World Health Organization say its risks range from short to long-term.

Researchers at Moi University College of Medicine in 2020 published the results of a study showing that the overuse of C-sections based on hospital guidelines was “significant,” with more than four out of 10 initial C-sections lacking proper documentation.

Gynecologist Hilary Mabia and colleagues analyzed the records of 12,209 women who gave birth at the Moi Teaching and Referral Hospital in 2014. Their study was published in the International Journal of Equity in Health.

The study concluded, “Our study shows that unneeded initial caesarean section and near-universal caesarean section play an important role in explaining both the overall rate of caesarean section and the socioeconomic disparities in caesarean sections.”

“Our study suggests that preventing unnecessary initial cesarean deliveries and promoting a safe labor experience with close monitoring in women with scarred uteruses can help reduce the C-section epidemic.”

Official data show that the prevalence of caesarean section increases with maternal age, education level, number of antenatal care visits, and wealth status.

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About 33 percent of live births to women in the wealthiest quintile were delivered by caesarean section, compared with 5 percent of births to women in the bottom quintile.

Women categorized as poor, with little or no education and residing in rural areas score lower levels of C-section, confirming Ms. Jomo’s view that social status and medical coverage have a significant impact on mode of delivery.

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