Maternal request CS--role of hospital teaching status and for-profit ownership.
OBJECTIVE
To examine whether hospitals' for-profit (FP) ownership and non-teaching status are associated with greater likelihood of maternal request cesarean (CS) relative to public and not-for-profit (NFP) and teaching status, respectively.


METHODS
Retrospective, cross-sectional, population-based study of Taiwan's National Health Insurance claims data, covering all 739,531 vaginal delivery-eligible singleton deliveries during 1997-2000, using multiple logistic regression analyses.


RESULTS
Adjusted for maternal age and geographic location, FP district hospitals (almost all non-teaching), followed by ob/gyn clinics were significantly more likely to perform request CS (OR=3.5-2.3) than public and NFP teaching hospitals. Among non-teaching and teaching hospitals, FPs were more likely to perform request CS than public and NFP hospitals (OR=2.3 and 2.5, respectively).


CONCLUSIONS
Our findings are consistent with greater propensity of physicians in FP institutions to accommodate patient requests involving revenue-maximizing procedures such as request CS. This effect is moderated by teaching hospitals' preference for complicated cases, consistent with their teaching mission and hi-tech infrastructure.
Xirasagar
Sudha
S
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Lin
Herng-Ching
HC
D000328:Adult; D016550:Birthing Centers / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006777:Hospitals, Proprietary / Q000191:economics / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D010067:Ownership; D010358:Patient Participation / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D013624:Taiwan