Finkler M D, Wirtschafter D D
Lawrence University, Appleton, WI 54912-0599.
Inquiry. 1993 Summer;30(2):208-15.
Third-party insurers typically pay at least 50% more for cesarean sections than for vaginal deliveries, suggesting that a reduced national cesarean-section rate could save payers more than $1 billion annually. This paper discusses the payment implications of a cost-effectiveness study, based on the experience within one health maintenance organization, in which cesarean-section rates were unrelated either to direct costs or to perinatal outcomes. Given these results, insurers should consider paying a flat fee for obstetric services unless differing risk levels or risk-adjusted outcomes justify different amounts.
第三方保险公司通常为剖宫产支付的费用比顺产至少高出50%，这表明全国剖宫产率的降低每年可为支付方节省超过10亿美元。本文基于一个健康维护组织的经验，讨论了一项成本效益研究的支付影响，在该组织中，剖宫产率与直接成本或围产期结局均无关。鉴于这些结果，除非不同的风险水平或风险调整后的结局证明金额不同是合理的，否则保险公司应考虑为产科服务支付统一费用。
