Graduate Institute of Healthcare Administration, Kaohsiung Medical University, Kaohsiung, Taiwan.
BMC Pregnancy Childbirth. 2009 Dec 18;9:59. doi: 10.1186/1471-2393-9-59.
The use of tocolytic hospitalization in antenatal care is controversial and worthy of more research. We investigated individual, institutional, and area factors that affect the use of tocolytic hospitalizations in Taiwan where fertility has rapidly declined.
Longitudinal data from the 1996 to 2004 National Health Insurance Research Database in Taiwan were used to identify tocolytic hospitalizations. The probit model was used to estimate factors associated with tocolytic hospitalizations.
The decline in fertility was significantly associated with the probability of tocolytic hospitalizations. Several physician and institutional factors-including physician's age, hospital ownership, accreditation status, bed size, and teaching status-were also significantly correlated to the dependent variables.
The provision of inpatient tocolysis is influenced not only by clinical considerations but also by physician, institutional, and area factors unrelated to clinical need. Fertility declines in Taiwan may have led obstetricians/gynecologists to provide more tocolysis to make up for their lost income. If the explanation is further validated, reimbursement policies may need to be reviewed to correct for overuse of inpatient tocolysis. The correlation could also be explained by the increasing use of artificial reproductive technologies and higher social value of newborns. In addition, the physician and institutional variations observed in the study indicate potential misuse of inpatient tocolysis that warrant further investigation.
产前保健中使用保胎治疗存在争议，值得进一步研究。我们调查了个体、机构和地区因素，这些因素影响了在生育率迅速下降的台湾使用保胎治疗住院的情况。
使用台湾 1996 年至 2004 年国家健康保险研究数据库的纵向数据来确定保胎治疗住院的情况。使用概率模型来估计与保胎治疗住院相关的因素。
生育率的下降与保胎治疗住院的概率显著相关。一些医生和机构因素，包括医生的年龄、医院所有权、认证状态、床位数和教学地位，也与因变量显著相关。
住院保胎治疗的提供不仅受临床考虑的影响，还受与临床需求无关的医生、机构和地区因素的影响。台湾生育率的下降可能导致妇产科医生提供更多的保胎治疗来弥补他们的收入损失。如果这一解释得到进一步验证，可能需要审查报销政策，以纠正住院保胎治疗的过度使用。这种相关性也可以用越来越多的使用人工生殖技术和更高的新生儿社会价值来解释。此外，研究中观察到的医生和机构之间的差异表明，住院保胎治疗可能存在潜在的滥用，需要进一步调查。
