The failure of financial incentive? The seemingly inexorable rise of cesarean section
The failure of financial incentive? The seemingly inexorable rise of cesarean section
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DOI：
10.1016/j.socscimed.2013.11.010
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发表时间：
2014-01-01
影响因子：
5.4
通讯作者：
Lin, Chung-Liang
中科院分区：
文献类型：
--
作者：
Chen, Chin-Shyan;Liu, Tsai-Ching;Lin, Chung-Liang
台湾在2005年和2006年分别实施了两项旨在减缓剖腹产使用率增长的政策干预措施。第一项政策为鼓励阴道分娩提供了财政奖励，规定了产科服务的全球费用，实质上将阴道分娩的报销提高到与剖腹产相同的水平。第二项政策旨在减少对选择性剖宫产手术的需求，在医学上没有剖腹产指征的情况下，采用共同支付。本文利用2003-2008年国家医疗保险研究数据库中的数据，考察了供需双方的经济激励对剖宫产使用率的影响。我们发现，虽然剖腹产使用率的总体趋势似乎对干预措施没有反应，但政策确实对其选择性使用产生了重大影响。对提供者的财政激励确实很重要，而政策干预，如改变费用，仍然是减少过度使用剖腹产的重要战略。(C)爱思唯尔有限公司出版的2013年。
Two policy interventions in Taiwan aiming to slow the growth of cesarean delivery utilization were respectively implemented in 2005 and 2006. The first policy provided financial incentives to encourage vaginal delivery by setting a global fee for obstetric services and in essence increasing the reimbursement for vaginal delivery up to the same level of cesarean section. The second policy aimed to reduce the demand for elective cesarean procedure by employing a copayment when cesarean section is not medically indicated. This paper examines the impact of financial incentives of both the supply and the demand side on the use of utilization of cesarean section using data from the 2003-2008 National Health Insurance Research Database. We found that while the overall trend of cesarean utilization did not seem to respond to the interventions, the policies did have significant impact on its elective use. Financial incentives for the providers do matter, and policy interventions, such as a fee change, are still important strategies to consider in reducing the over-utilization of cesarean section. (C) 2013 Published by Elsevier Ltd.