title: Taiwan's high rate of cesarean births: impacts of national health insurance and fetal gender preference.
abstract: BACKGROUND
  Taiwan has a high rate of cesarean section, approximately 33 percent in the past decade. This study investigates and discusses 2 possible factors that may encourage the practice, one of which is fetal gender difference and the other is Taiwan's recently implemented National Health Insurance (NHI).
  
  
  METHODS
  A logistic regression model was used with the 1989 and 1996 National Maternal and Infant Health Survey and with the 2001 to 2003 NHI Research Databases.
  
  
  RESULTS
  Using survey data, we found a statistically significant 0.3 percent gender difference in parental choice for cesarean section. However, no statistically significant difference was found in the rate of cesarean section before and after NHI implementation.
  
  
  CONCLUSIONS
  Taiwan's high cesarean section rate is not directly related to financial incentives under NHI, indicating that adjusting policy to lower financial incentives from NHI would have only limited effect. Likewise, focusing effort on the small gender difference is unlikely to have much impact. Effective campaigns by health authorities might be conducted to educate the general population about risks associated with cesarean section and the benefits of vaginal birth to the child, mother, and society.
authors.affiliation: Department of Public Finance, and Taipei Municipal Wan Fang Hospital, and Department of Economics, National Taipei University, Taiwan.
authors.forename: Tsai-Ching
authors.initials: TC
authors.lastname: Liu
authors.forename: Chin-Shyan
authors.initials: CS
authors.lastname: Chen
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Tsai
authors.forename: Herng-Ching
authors.initials: HC
authors.lastname: Lin
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D003466:Cultural Characteristics; D003657:Decision Making; D005260:Female; D005783:Gender Identity; D006266:Health Education / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D007229:Infant Welfare / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D019458:Insurance Coverage; D016015:Logistic Models; D009313:National Health Programs / Q000191:economics*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration; D011787:Quality of Health Care; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology