title: Do cesarean deliveries on maternal request lead to greater maternal care utilization during six-month, one-year, and two-year postpartum periods? Evidence from NHI claims data in Taiwan.
abstract: OBJECTIVE
  The purpose of the study is to examine whether women who have undergone cesarean deliveries on maternal request (CDMR) have a higher utilization of outpatient and inpatient obstetric and gynecological services than do those with vaginal deliveries (VD).
  
  
  METHODS
  We use two population-based claims datasets to trace the six-month, one-year, and two-year postpartum periods (PP) medical care utilizations by women who have undergone CDMRs or VDs during 2002 in Taiwan. The paper analyses the utilization of services through logistic, negative binomial, linear, and log-linear regressions based on the data types.
  
  
  RESULTS
  We find that CDMRs are associated with a greater utilization of medical care than are VDs. Compared to mothers who have undergone VDs, those who underwent CDMRs have a greater likelihood to have additional outpatient visits (by 9.6% for six-month PP and 7.5% for one-year PP) and re-hospitalization (by 0.24%, 0.3%, and 0.66% for the three PPs, respectively), more outpatient revisits (by 0.47, 0.66, and 1.07, respectively), greater outpatient expenditure (by NT$324 for one-year PP) and inpatient expenditure (by NT$6178, NT$5992, and NT$5484, respectively).
  
  
  CONCLUSIONS
  Cesarean deliveries on maternal request lead to significant negative outcomes during the postpartum period, which should be taken into account in the cost-benefit calculation.
authors.affiliation: Department of Public Finance, National Taipei University, 151, University Road, San Shia, New Taipei City, Taiwan. Electronic address: tching@mail.ntpu.edu.tw.
authors.forename: Tsai-Ching
authors.initials: TC
authors.lastname: Liu
authors.affiliation: Department of Economics and Geography, Coggin College of Business, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA. Electronic address: cloh@unf.edu.
authors.forename: Chung-Ping Albert
authors.initials: CP
authors.lastname: Loh
authors.affiliation: Department of Economics, National Dong Hwa University, 1, Sec. 2, Da-Hsueh Road, Shou-Feng, Hualien 97401, Taiwan. Electronic address: cllin@mail.ndhu.edu.tw.
authors.forename: Chung-Liang
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Department of Economics, National Taipei University, 151, University Road, San Shia, New Taipei City, Taiwan. Electronic address: stan@mail.ntpu.edu.tw.
authors.forename: Chin-Shyan
authors.initials: CS
authors.lastname: Chen
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D013624:Taiwan; D055815:Young Adult
keywords: Cesarean deliveries; Long-term outcome; Maternal care utilization; Postpartum; Taiwan; Vaginal deliveries