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September 2002, Vol 92, No. 9 | American Journal of Public Health 1514-1517
© 2002 American Public Health Association

RESEARCH AND PRACTICE

National Health Insurance, Physician Financial Incentives, and Primary Cesarean Deliveries in Taiwan

Yi-Wen Tsai, PhD and Teh-wei Hu, PhD

Yi-wen Tsai is with the National Health Research Institutes, Taipei, Taiwan. Teh-Wei Hu is with the School of Public Health, University of California, Berkeley.

Correspondence: Requests for reprints should be sent to Yi-Wen Tsai, PhD, Division of Health Policy Research, National Health Research Institutes, 2F, 109, Min-Chuan East Road, Section 6, Taipei 114, Taiwan, ROC (e-mail: ivytsai{at}nhri.org.tw).

Objectives. Taiwan’s National Health Insurance Program (NHI) was implemented on March 1, 1995. This study analyzed the influences of the Case Payment method of reimbursement for inpatient care and of physician financial incentives on a woman’s choice for primary cesarean delivery.

Methods. Logistic regressions were used to analyze 11 788 first-time deliveries in a nonprofit hospital system between March 1, 1994, and February 29, 1996.

Results. After implementation of the NHI’s Case Payment scheme, the likelihood that a woman would choose primary cesarean delivery increased by four to five times compared with the choice behavior of uninsured individuals prior to NHI (P < .0001).

Conclusion. Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.




This article has been cited by other articles:


Home page
 Am. J. Public HealthHome page
C.-N. Liu and M.-C. Yang
RETHINKING "WOMAN'S CHOICE" OF CESAREAN DELIVERY
Am J Public Health, July 1, 2003; 93(7): 1036 - 1037.
[Full Text] [PDF]

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Rethinking "Woman's Choice" of Cesarean Delivery
Chia N. Liu, et al.
AJPH Online, 15 Jan 2003 [Full text]

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