Mohammadshahi Marita, Hematyar Hasan, Najafi Masoumeh, Alipouri Sakha Minoo, Pourreza Abolghasem
Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Public Health. 2018 Nov;47(11):1709-1716.
The rate of caesarean section (C-section) in Iran is too high, so having a plan to control it is crucial. Since one of the most important reasons for inclination of providers to do C-section is financial issues, the purpose of this study was offering financial solutions for increasing normal vaginal delivery (NVD) and decreasing non-indicated C-section.
This analytical-descriptive research, used game theory for offering financial mechanisms. The game was a dynamic one in which the backward induction was used to obtain a Nash equilibrium. Financial structure and the mean number of NVD and C-section in a certain period of time in comparison with standards were as the main influential factors on financial dimensions and were included in the model.
The effect of financial structure was shown through a specified insurance for childbirth, existence of a monitoring department and tariffs.
The main solution for controlling C-section in designed game was taxes and fines for physician or hospital in non- indicated cases and giving reward otherwise.
伊朗剖宫产率过高，因此制定控制计划至关重要。由于医疗服务提供者倾向于进行剖宫产的最重要原因之一是财务问题，本研究的目的是提供财务解决方案，以增加自然阴道分娩并减少非指征性剖宫产。
本分析描述性研究运用博弈论提供财务机制。该博弈是动态博弈，采用逆向归纳法获得纳什均衡。财务结构以及特定时间段内自然阴道分娩和剖宫产的平均数量与标准相比，作为财务维度的主要影响因素并纳入模型。
财务结构的影响通过特定的生育保险、监测部门的存在和收费标准得以体现。
在设计的博弈中，控制剖宫产的主要解决方案是对非指征性病例中的医生或医院征税和罚款，否则给予奖励。
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