ArticleMedicine2025
How cesarean section rates can be reduced through an effective financial strategy: A protocol for systematic review.
Article in Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundThe incidence of cesarean section (c-section) has been increasing after the introduction of national health coverage. There is potential evidence that unnecessary c-sections can be reduced through an effective financial strategy, which would make it possible to increase health equity in the future. Consistent with global trends, the rate of c-section in Indonesia increased from 1.6% in 1991 to 17.6% in 2017, while the World Health Organization standard rate is 10% to 15%. This study aims to explore and analyze strategies to reduce c-section rates and to report evidence-based research on an effective financial strategy model for reducing these rates.
methodsWe used a systematic review framework involving electronic databases including PubMed, ProQuest, and ScienceDirect. The following literature search terms were used: "cost-benefit analysis," "universal health care," "cost controls," "health expenditures," "out-of-pocket expenses," "c-section," and "abdominal delivery." The Joanna Briggs Institute critical appraisal checklist was used to independently assess the methodological quality. The findings were compiled using a meta-aggregation approach to summarize quantitative analysis results potentially based on different methodologies.
resultsAmong 883 database records, 26 studies were retained for full-text review. C-section risk factors, the role of financial system evaluation, and the application of the clinical audit cycles with assessments using Robson classification were discussed in the included papers. Several studies highlighted the crucial function of evaluating reward reimbursement schemes, suggesting that decreased c-section rates and other maternal-neonatal outcomes should be used as indicators. DISCUSSION: This study identified an evidence base that suggests using Robson classification in clinical audit cycles to reduce c-section rates and avoid unnecessary c-sections. The other proposals for decreasing the rate were mainly focused on financial and nonfinancial strategies applied nationally and locally in hospital settings.
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Registered trials
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