title: Impact of Provider Competition under Global Budgeting on the Use of Cesarean Delivery.
abstract: To examine the impact of provider competition under global budgeting on the use of cesarean delivery in Taiwan.
  
  
  
  (1) Quarterly inpatient claims data of all clinics and hospitals with birth-related expenses from 2000 to 2008; (2) file of health facilities' basic characteristics; and (3) regional quarterly point values (price conversion index) for clinics and hospitals, respectively, from the fourth quarter in 1999 to the third quarter in 2008, from the Statistics of the National Health Insurance Administration.
  
  
  
  Panel data of quarterly facility-level cesarean delivery rates with provider characteristics, birth volumes, and regional point values are analyzed with the fractional response model to examine the effect of external price changes on provider behavior in birth delivery services.
  
  
  
  The decline in de facto prices of health services as a result of noncooperative competition under global budgeting is associated with an increase in cesarean delivery rates, with a high degree of response heterogeneity across different types of provider facilities.
  
  
  
  While global budgeting is an effective cost containment tool, intensified financial pressures may lead to unintended consequences of compromised quality due to a shift in provider practice in pursuit of financial rewards.
authors.affiliation: Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Bradley
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Economics, Public Finance and Finance Research Center, National Taipei University, San Shia, New Taipei City, Taiwan.
authors.forename: Chin-Shyan
authors.identifier: 0000-0002-6314-8171
authors.initials: CS
authors.lastname: Chen
authors.affiliation: Department of Public Finance, Public Finance and Finance Research Center, National Taipei University, New Taipei City, Taiwan.
authors.forename: Tsai-Ching
authors.initials: TC
authors.lastname: Liu
mesh_terms: D000328:Adult; D000367:Age Factors; D002017:Budgets / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data*; D003363:Cost Control / Q000379:methods / Q000706:statistics & numerical data*; D004465:Economic Competition / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data; D013624:Taiwan; D055815:Young Adult
keywords: Cesarean delivery; global budgeting; provider behavior; quality of health care; reimbursement incentive