Bland E S, Oppenheimer L W, Holmes P, Wen S W
Division of Maternal-Fetal Medicine, Department of Obstetrics, University of Ottawa.
CMAJ. 2001 Feb 6;164(3):337-9.
On July 1, 1997, the call group at a tertiary referral hospital in Ottawa changed its remuneration. The authors tested the hypothesis that change in an obstetric call group's remuneration from individual fee-for-service billing to equal sharing of the pooled group income would result in reduced rates of obstetric intervention.
Intervention rates were compared for the 12 months before (1678 births) and the 12 months after (1934 births) the change. Data were collected on onset of labour, indication for induction of labour, mode of delivery and neonatal outcome. Statistical analysis was performed with Wilcoxon's signed-rank test.
The mean rate of elective induction of labour was 38.6% in the year before the change and 33.3% in the year after the change (p = 0.01). There were small but statistically significant increases in the mean duration of labour and mean length of the second stage (p = 0.03).
Billing policy may affect clinical decisions. Our findings add weight to the literature showing increased intervention rates with fee-for-service remuneration.
1997年7月1日，渥太华一家三级转诊医院的呼叫小组改变了薪酬方式。作者检验了这样一个假设，即产科呼叫小组的薪酬方式从个人按服务收费改为平均分配集体收入，会导致产科干预率降低。
比较了薪酬方式改变前12个月（1678例分娩）和改变后12个月（1934例分娩）的干预率。收集了分娩开始时间、引产指征、分娩方式和新生儿结局的数据。采用威尔科克森符号秩检验进行统计分析。
改变前一年择期引产的平均发生率为38.6%，改变后一年为33.3%（p = 0.01）。平均产程和第二产程平均时长有小幅但具有统计学意义的增加（p = 0.03）。
计费政策可能会影响临床决策。我们的研究结果进一步证明了文献中所显示的按服务收费薪酬方式会导致干预率增加这一观点。
