National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan.
OBJECTIVE
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).


CONCLUSIONS
Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.
Tsai
Yi-Wen
YW
National Health Research Institutes, Taipei, Taiwan. ivyt-sai@nhri.org.tw
Hu
Teh-Wei
TW
D000328:Adult; D002585:Cesarean Section / Q000191:economics* / Q000706:statistics & numerical data*; D003657:Decision Making; D005245:Fee Schedules; D005260:Female; D005382:Financing, Personal; D006302:Health Services Research; D006788:Hospitals, Voluntary; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D009313:National Health Programs / Q000191:economics*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011247:Pregnancy; D012052:Reimbursement, Incentive; D013624:Taiwan