Keeler E B, Brodie M
Harvard University.
Milbank Q. 1993;71(3):365-404.
The dramatic rise in cesarean-section (C-section) rates, and their high costs and wide variation, has raised interest in understanding the factors affecting decisions to use this procedure. The economic incentives of physicians, hospitals, payers, and mothers are examined. In the economic framework, physicians must balance their short-term interests against their reputation, which is derived from efficiently providing what mothers want. Providers who encounter higher opportunity costs while attending to mothers in prolonged labor can reduce these costs by operating or by restructuring their practices. The mainly indirect evidence on financial incentives indicates that insured mothers have low marginal financial costs when they undergo C-section. Mothers with private, fee-for-service insurance have higher C-section rates than mothers who are covered by staff-model HMOs, who are uninsured, or who are publicly insured. In conclusion, research and payment reforms to reduce distortions to good practice are proposed.
剖宫产（C -section）率的急剧上升及其高昂成本和巨大差异，引发了人们对了解影响该手术使用决策因素的兴趣。本文考察了医生、医院、支付方和产妇的经济激励因素。在经济框架中，医生必须在短期利益与声誉之间取得平衡，而声誉源于高效提供产妇所需。在处理长时间分娩的产妇时面临较高机会成本的医疗服务提供者，可以通过手术或调整业务方式来降低这些成本。关于经济激励的主要间接证据表明，参保产妇进行剖宫产时的边际财务成本较低。拥有私人按服务收费保险的产妇剖宫产率高于参加员工型健康维护组织（HMO）、未参保或参加公共保险的产妇。总之，本文提出了旨在减少对良好医疗行为扭曲的研究和支付改革建议。
