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Aladin Aladin,1 Werry Darta Taifur,2 Syed Mohamed Aljunid,3 Dwiana Ocviyanti4 1Department of Obstetrics and Gynecology, Andalas University, Padang, West Sumatra, Indonesia; 2Department of Economics, Andalas University, Padang, West Sumatra, Indonesia; 3Department of Public Health and Community Medicine, International Medical University, Kuala Lumpur, Selangor, Malaysia; 4Department of Obstetrics and Gynecology, University of Indonesia, Jakarta, IndonesiaCorrespondence: Aladin Aladin, Email dr.aladin.spog@gmail.comIntroduction: As with several countries around the world, cesarean section rates are increasing also in Indonesia, raising issues of quality and cost-effectiveness of health care, especially with the shift from a fee-for-service to a prospective payment system. For hospital services to be effective (quality control) and efficient (cost control), clinical pathways are essential. However, no studies have been done to develop a clinical pathway for cesarean sections (CS) in the INA-CBG system that is both effective and efficient.Objective: To develop clinical pathways for CS that are both effective and efficient by determining unit costs and tariffs for CS services, reviewing procedures and outcomes, and assessing performance efficiency and effectiveness.Methods: Using a sample of 110 patients undergoing cesarean sections consecutively recruited in 11 hospitals of West Sumatra (6 public hospitals and 5 private institutions), this mixed (qualitative and quantitative) study aimed at developing clinical guidelines for childbirth delivery modes responding both to criteria of efficacy and efficiency.Results: Of 110 patients, 50 patients (45%) had efficient CS, 85 patients (77%) had effective CS, and 40 patients (36.4%) had both effective and efficient CS. A comprehensive clinical pathway for CS procedure was created by investigating 40 patients who underwent effective and efficient CS using interviews, a Delphi study, and professional advice.Discussion: Hospitals can adopt the effective and efficient clinical pathway for CS protocol to prevent cost-related losses (efficient) while retaining the quality of the service (effective).Keywords: cesarean section, cost analysis, efficiency, effectiveness |
