The response from Swan to my article is appreciated. I find concerning the insights on how third-party managed care might have an adverse impact on patient rights and good medical practice. For example, Swan infers that subtotal compliance with antibiotic guidelines for caesarean deliveries is a quality concern. In scheduled caesarean deliveries, 100 patients must receive prophylactic antibiotics to avoid one infection-related complication.1 Material risks, such as anaphylaxis, plus uncertain consequences for the infant, must be disclosed. Accordingly, respect for informed decision making by mothers-to-be might better explain and justify a ceiling to guide uptake.
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- 1. Ledger W, Blaser M. Are we using too many antibiotics during pregnancy? BJOG 2013; 120: 1450-1452.
- 2. Howley PP, Hancock SJ, Gibberd RW, et al. Bayesian methods in reporting and managing Australian clinical indicators. World J Clin Cases 2015; 3: 625-634.
- 3. Sahadevan S, Earnest A, Koh YL, et al. Improving the diagnosis related grouping model's ability to explain length of stay of elderly medical inpatients by incorporating function-linked variables. Ann Acad Med Singapore 2004; 33: 614-622.
- 4. Gross PF. Singapore's health system: a model for Australia? Med J Aust 2014; 200: 513. <MJA full text>
- 5. Wouters OJ, McKee M. Private financing of health care in times of economic crisis: a review of the evidence. Global Policy 2016; doi: 10.1111/1758-5899.12211.
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