UAE doctors and health insurers clash over necessity of costly C-sections

Insurers say they are landed with a huge bill for deliveries that are up to four times as expensive than a natural birth, while healthcare providers say C-sections are a result of lifestyle here in the UAE and women having children later in life.

DUBAI // Health insurers say they are paying enormous amounts for the high number of women having Caesarean births, many of which they claim are unnecessary.

The World Health Organisation recommends Caesarean rates of 19 to 21 per cent, but the average figure in the UAE is closer to 36 per cent.

Health insurer MetLife has revealed that 46 per cent of its maternity cases were Caesareans last year, while Daman said it paid for surgery in 33.5 per cent of births in 2014.

C-sections cost up to Dh22,000 in private clinics, with bills spiralling as mothers can take twice as long recovering in hospital. There are also the fees for surgeons and anaesthetists.

Stephen MacLaren, head of sales at insurer Al Futtaim Willis, said too many C-sections were defined as medically necessary.

“If doctors say a C-section is required medically and people’s lives are at risk it becomes an emotional issue,” Mr MacLaren said. “It is a vulnerable point of health care that is exploited.

“Insurance companies I speak with are considering how they can make the definitions tighter of when a C-section is medically required. They look at low levels elsewhere and ask, ‘why is it so high in the UAE?’

“As a health system, it is an area potentially open to abuse. Insurers all believe some of the C-sections that are being done are debatable.”

Mark Adams, chief executive of healthcare provider Anglo Arabian Healthcare, admitted the UAE health system is “very commercial, with lots of doctors running their own businesses with overheads and profit targets”.

“In an ideal world, every doctor should be focused on the clinical outcome of the patient. Here there is a pressure to sustain revenue,” Mr Adams said.

“Many providers are operating at 30 per cent capacity. If you haven’t got enough patients you need to maximise your income, so that drives behavioural change.”

Dr Sherif Mahmoud, regional head of healthcare operations at Axa Insurance, said C-section rates were rising by up to 9 per cent a year. “Roughly, C-section ranges between 2.5 and 4 times the cost of normal delivery.”

At Latifa Hospital in Dubai, government figures from 1992 show that of 7,141 new mothers, 893 had a C-section — 12.5 per cent. Last year 1,764 mothers, or 34 per cent, had the surgery.

In Abu Dhabi, there were 35,945C-sections across all hospitals in 2013, almost 32 per cent of all births, although this figure increased to 33.5 per cent by 2014.

In the UK, the number of women having C-section births is about 25 per cent, and in 2014 the US had a figure of about 32 per cent.

Some doctors say the increase in C-sections is caused by lifestyle choices and women having children later in life, increasing the risk of complications.

Increasing use of IVF, which often results in multiple pregnancies, has also had an effect. In the UK, the multiple pregnancy rate is about 1.5 per cent but it is 3.47 per cent here.

Latifa had 162 cases of twins last year and 18 sets of triplets.

Women with gestational diabetes usually have to be induced, so reducing C-sections is a challenge for the UAE, where obesity rates are at 65 per cent, and one in five has diabetes. Dr Shiva Harikrishnan, head of obstetrics and gynaecology at Medeor 24X7 Hospital in Dubai, said fear of litigation could also be inflating the numbers of C-sections being carried out in private clinics, with doctors erring on the side of caution.

“We cannot afford to have any complications so sometimes there is a more defensive practice,” Dr Harikrishnan said.

“There has been an increase in maternal requests, so we need to spend more time counselling to understand why women are scared of a normal delivery. There is a higher morbidity rate with C-sections. Women need to understand there are risks.”

Dr Geetha Indira, Latifa Hospital’s specialist registrar in obstetrics and gynaecology, said women were counselled about the risk but often it came down to patient choice. “We’re trying to encourage more women to delivery normally,” Dr Indira said. “It is a major surgery and there could be more bleeding or a post-op infection.”

Dr Grace Jacob, a gynaecologist at City Centre Clinic Deira, said C-sections were not an easy choice. “All mothers think they are correct but doctors will not take surgery lightly,” she said. “C-sections are not done for our convenience.”