Weinstein R B, Trussell J
Office of Population Research, Princeton University, New Jersey, USA.
Am J Obstet Gynecol. 1998 Sep;179(3 Pt 1):657-64. doi: 10.1016/s0002-9378(98)70060-2.
We hypothesized that movement from traditional indemnity insurance to managed care in California between 1983 and 1994 would lead to reductions in the rate of cesarean delivery.
We decomposed the frequency of cesarean delivery with each primary diagnosis into the product of the diagnosis rate among all women and the cesarean delivery rate among women with the given diagnosis (conditional cesarean delivery rate). We used logistic regression to estimate the diagnosis and conditional cesarean delivery rates.
Adjusted and observed cesarean delivery rates are indistinguishable. Both the diagnosis rates and the conditional cesarean delivery rates contributed to the increase in the cesarean delivery rate between 1983 and 1987. The subsequent decline is attributable to the decline in the repeated cesarean delivery rate.
The increase in managed care in California played no apparent role in the decline in the cesarean delivery rate. With the exception of Kaiser health maintenance organizations, managed care providers and indemnity insurers managed deliveries similarly.
我们假设1983年至1994年间加利福尼亚州从传统的赔偿保险转向管理式医疗会导致剖宫产率下降。
我们将每种主要诊断的剖宫产频率分解为所有女性中的诊断率与具有给定诊断的女性中的剖宫产率（条件剖宫产率）的乘积。我们使用逻辑回归来估计诊断率和条件剖宫产率。
调整后的剖宫产率与观察到的剖宫产率没有区别。诊断率和条件剖宫产率都导致了1983年至1987年间剖宫产率的上升。随后的下降归因于重复剖宫产率的下降。
加利福尼亚州管理式医疗的增加在剖宫产率下降中没有起到明显作用。除了凯撒健康维护组织外，管理式医疗提供者和赔偿保险公司对分娩的管理方式类似。
