A pilot scheme by the Health Insurance Organisation (HIO) to incentivise gynaecologists and obstetricians to perform natural births instead of caesareans (C-sections) has been rolled out.

The pilot comes ahead of new clinical guidelines expected in the first quarter of this year after which it will be fully implemented, according to the HIO, which presented the plan to doctors last July.

Under the plan, doctors will receive incentives to perform natural births, while those performing C-sections over a certain quota will be penalised.

The plan proposes that those who keep the number of uncomplicated C-sections they perform within certain limits will receive an up to 15 per cent increase in compensation. Conversely, those who exceed the set limits will face reductions, reaching up to 35 per cent in extreme cases.

According to data from the health ministry, C-sections in Cyprus in 2021 accounted for 59 per cent of births, compared to an EU average of below 30 per cent, rising even further in subsequent years. WHO guidelines say the limit should be 15 per cent of all live births.

In 2022, out of 10,373 births in Cyprus, 60 per cent were C-sections. By 2023, that percentage increased to 62.31 per cent.

Data previously presented to MPs revealed that in 2021, only 15-17 per cent of C-sections were performed to save the mother and child. Another 40 per cent were planned, and 38 per cent were recorded as being by the mother’s choice.

Under the plan, the HIO will monitor caesarean sections rates monthly against the total number of deliveries per doctor, per hospital. Each month the physician and nursing facility will receive a cumulative statement of that rate. At the end of each year, the agency will award or penalise the doctors.

Under the plan, a doctor who records a percentage of uncomplicated C-sections below 30 per cent of total deliveries will receive a 15 per cent bonus on the total income of all deliveries performed in that hospital (if a doctor collaborates with more than one hospital, the bonus will be cumulative).

A doctor who performs 30-40 per cent of uncomplicated C-sections will receive a 5 per cent reward on the total income of all deliveries performed. Meanwhile, a doctor who exceeds 40 per cent will receive a penalty on half of the income from the uncomplicated C-sections performed.

If the percentage of uncomplicated C-sections is between 60-70 per cent, the penalty will be a 10 per cent reduction, increasing to 15 per cent for 70-80 per cent, and up to 35 per cent for performing C-sections more than 90 per cent of the time.