Department of Economics, National Taipei University, Taiwan.
Department of Public Finance, National Taipei University, 151, University Rd., San Shia, New Taipei City 237, Taiwan.
Soc Sci Med. 2014 Jan;101:47-51. doi: 10.1016/j.socscimed.2013.11.010. Epub 2013 Nov 15.
Two policy interventions in Taiwan aiming to slow the growth of cesarean delivery utilization were respectively implemented in 2005 and 2006. The first policy provided financial incentives to encourage vaginal delivery by setting a global fee for obstetric services and in essence increasing the reimbursement for vaginal delivery up to the same level of cesarean section. The second policy aimed to reduce the demand for elective cesarean procedure by employing a copayment when cesarean section is not medically indicated. This paper examines the impact of financial incentives of both the supply and the demand side on the use of utilization of cesarean section using data from the 2003-2008 National Health Insurance Research Database. We found that while the overall trend of cesarean utilization did not seem to respond to the interventions, the policies did have significant impact on its elective use. Financial incentives for the providers do matter, and policy interventions, such as a fee change, are still important strategies to consider in reducing the over-utilization of cesarean section.
台湾有两项旨在降低剖宫产率的政策干预措施，分别于 2005 年和 2006 年实施。第一项政策通过设定产科服务的总费用，实质上提高了阴道分娩的报销比例，从而为鼓励阴道分娩提供了经济激励。第二项政策则通过在非医学指征剖宫产时收取额外费用来减少选择性剖宫产的需求。本研究利用 2003-2008 年全民健康保险研究数据库的数据，检验了供需双方的经济激励措施对剖宫产使用率的影响。结果发现，尽管剖宫产总体使用率的趋势似乎并未对这些干预措施产生反应，但这些政策确实对选择性剖宫产的使用产生了显著影响。提供者的经济激励措施确实很重要，而且费用调整等政策干预措施仍然是减少剖宫产过度使用的重要策略。
