Cost and Quality Control Model for The Clinical Pathway of Cesarean Section

Background: Cesarean section (CS) incidents are increasing in some parts of the world, which are not accompanied by improved service quality and cost-efficiency. Changes in the pattern of health financing from a fee-for-service to a prospective payment (case-mix system) are considered the cause. Clinical pathways are essential for achieving effectiveness (quality control) and efficiency (cost control) in hospital services. However, there has been no prior research on developing a cost and quality control model for CS in the INA-CBG's system. Objective: This study aims to develop a cost and quality control model for the clinical pathway of CS by calculating unit costs and tariffs, reviewing procedures and outcomes, and evaluating performance efficiency and effectiveness. Methods: From August 2021 to April 2022, 110 CS patients from 11 hospitals in West Sumatra that provide CS services participated in this study. The study implemented a mixed-method design and utilized Thiagarajan's 4-D model, which integrates interviews, surveys, and recommendations, to develop a prototype model that will be validated again to establish a permanent model. Results: Of the 110 patients, 45% were efficient, while 77% were effective. Furthermore, 40 patients (36.4%) underwent efficient and effective CS. A prototype of a cost and quality control model for the clinical pathway of CS was developed by analyzing 40 patients with in-depth interviews, a Delphi study, and professional recommendations. Conclusion: Hospitals can use cost-effective and high-quality clinical pathways for CS services.