title: The immediate effects of the severe acute respiratory syndrome (SARS) epidemic on childbirth in Taiwan.
abstract: BACKGROUND
  When an emerging infectious disease like severe acute respiratory syndrome (SARS) strikes suddenly, many wonder the public's overwhelming fears of SARS may deterred patients from seeking routine care from hospitals and/or interrupt patient's continuity of care. In this study, we sought to estimate the influence of pregnant women's fears of severe acute respiratory syndrome (SARS) on their choice of provider, mode of childbirth, and length of stay (LOS) for the delivery during and after the SARS epidemic in Taiwan.
  
  
  METHODS
  The National Health Insurance data from January 01, 2002 to December 31, 2003 were used. A population-based descriptive analysis was conducted to assess the changes in volume, market share, cesarean rate, and average LOS for each of the 4 provider levels, before, during and after the SARS epidemic.
  
  
  RESULTS
  Compared to the pre-SARS period, medical centers and regional hospitals dropped 5.2% and 4.1% in market share for childbirth services during the peak SARS period, while district hospitals and clinics increased 2.1% and 7.1%, respectively. For changes in cesarean rates, only a significantly larger increase was observed in medical centers (2.2%) during the peak SARS period. In terms of LOS, significant reductions in average LOS were observed in all hospital levels except for clinics. Average LOS was shortened by 0.21 days in medical centers (5.6%), 0.21 days in regional hospitals (5.8%), and 0.13 days in district hospitals (3.8%).
  
  
  CONCLUSIONS
  The large amount of patients shifting from the maternity wards of more advanced hospitals to those of less advanced hospitals, coupled with the substantial reduction in their length of maternity stay due to their fears of SARS could also lead to serious concerns for quality of care, especially regarding a patient's accessibility to quality providers and continuity of care.
authors.affiliation: Institute of Health Care and Hospital Administration, National Yang Ming University, 155 Li-Nong Street, Section 2, Taipei, 112 Taiwan. chlee@mail.nhi.gov.tw
authors.forename: Cheng-Hua
authors.initials: CH
authors.lastname: Lee
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.forename: Hong-Jen
authors.initials: HJ
authors.lastname: Chang
authors.forename: Yea-Jen
authors.initials: YJ
authors.lastname: Hsu
authors.forename: Mei-Chu
authors.initials: MC
authors.lastname: Wang
authors.forename: Yiing-Jenq
authors.initials: YJ
authors.lastname: Chou
mesh_terms: D000328:Adult; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D004196:Disease Outbreaks; D005239:Fear; D005260:Female; D019981:Health Care Sector; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology