Lo Joan C
Institute of Economics and Center for Institution and Behavior Studies, Research Center for Humanities and Social Science, Academia Sinica, Nankang, Taipei, Taiwan.
Health Policy. 2008 Oct;88(1):121-9. doi: 10.1016/j.healthpol.2008.02.013. Epub 2008 Apr 23.
To test the hypothesis that cesarean sections are less likely to be performed after equalizing the fees for vaginal births and cesarean sections.
Population-based National Health Insurance inpatient claims in Taiwan are used. Pre-periods and post-periods are identified to investigate the impact of the policy changes. Logistic regressions are employed.
The cesarean section rates for the first, second and higher-order births are 29, 37.4 and 39.3%, while the primary cesarean section rates are 29, 11.8 and 12.1%, respectively. After taking into consideration the case-mix and birth order, the second and higher-order births were approximately 60% less likely to be cesarean deliveries compared to the first births and the increase in the VBAC fee had an additional negative effect on them. A fee equalization policy was not found to influence the cesarean delivery. The total cesarean section rate was primarily determined by the cesarean section rate for the first birth.
Cesarean section rates are greater for the higher-order births because of the practice "once a cesarean section, always a cesarean section". Against the background of a rapidly declining fertility rate, females play a more important role in the mode of delivery than ever before. As such, financial incentives designed specifically for obstetricians do not have the desired impact. Policies that are aimed at altering behavior should be designed within the social context.
检验在使顺产和剖宫产费用均等后剖宫产手术实施可能性降低这一假设。
使用台湾地区基于人群的国民健康保险住院理赔数据。确定前期和后期以调查政策变化的影响。采用逻辑回归分析。
初产、经产及多胎分娩的剖宫产率分别为29%、37.4%和39.3%，而首次剖宫产率分别为29%、11.8%和12.1%。在考虑病例组合和产次后，经产及多胎分娩的剖宫产可能性比初产低约60%，且VBAC（剖宫产后阴道分娩）费用增加对其有额外负面影响。未发现费用均等政策对剖宫产有影响。剖宫产总率主要由初产剖宫产率决定。
由于“一次剖宫产，永远剖宫产”的做法，经产及多胎分娩的剖宫产率更高。在生育率迅速下降的背景下，女性在分娩方式中发挥着比以往更重要的作用。因此，专门针对产科医生的经济激励措施并未产生预期效果。旨在改变行为的政策应在社会背景下制定。
