The relationship between payer type and quality of care for women undergoing emergency cesarean section at three hospitals in rural Uganda.

Abstract

Synopsis Post-operative quality of care for emergency C-section cases, measured by length of stay in Ugandan rural hospitals, is impacted by case management. Background The study examined the relationship between payer type, and quality of care among mothers who deliver through emergency cesarean section in rural Ugandan hospitals. Methods We analyzed retrospective, de-identified patient data from three rural private-not-for-profit hospitals in Uganda. Two groups were included in the study, a self-payer patient group and a group fully sponsored by an international funding organization. The data was analyzed using hierarchical linear regression models comparing length of stay against payer type, and controlling for patient age, education level, parity, and indication for C-section. Length of stay (LOS) was assumed to represent a realistic proxy variable for patient quality of care. Results The self-pay group had statistically significant longer postoperative LOS (surgery to clinical discharge), and longer aggregate LOS, or admission to clinical discharge, compared to the sponsored group. Payer type was not significant in the admission-to-decision LOS, but payer type was highly significant for aggregate LOS (p < .001). Conclusion Case management in rural Ugandan hospitals influences quality of post-operative care for patients undergoing emergency C-sections. Expanding surgical funding, combined with effective case management approaches, is likely to increase quality of surgical care as measured by length of stay.