Janowitz B, Wallace S, Araujo G, Araujo L
J Health Polit Policy Law. 1984 Fall;9(3):515-26. doi: 10.1215/03616878-9-3-515.
This paper examines factors associated with the cesarean birth rate, including medical condition and method of payment, in the largest maternity hospital of Fortaleza, Brazil. Data were collected on 5996 women who delivered at the Maternidade Escola Assis Chateaubriand from October 1980 to July 1981. All women were classified according to how they paid for their care: private (financed at least part of their care with own funds), insured (federal or state), or indigent. Private patients were found to be far more likely than patients in the other two groups to have cesarean deliveries, due primarily to the high percentage of private patients recorded as having prolonged or obstructed labor, combined with a high rate of prior cesarean sections. From this data, it appears likely that financial incentives did play a role in physician decisions on whether to perform cesarean deliveries.
本文研究了巴西福塔莱萨最大的妇产医院中与剖宫产率相关的因素，包括医疗状况和支付方式。收集了1980年10月至1981年7月在阿西斯·夏多布里昂妇产学校分娩的5996名妇女的数据。所有妇女都根据其护理费用支付方式进行分类：自费（至少部分护理费用由自己支付）、参保（联邦或州）或贫困。结果发现，自费患者进行剖宫产的可能性远高于其他两组患者，主要原因是记录为产程延长或难产的自费患者比例较高，同时既往剖宫产率也很高。从这些数据来看，经济激励措施似乎确实在医生决定是否进行剖宫产时起到了作用。
