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The failure of financial incentive? The seemingly inexorable rise of cesarean section

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  • Chen, Chin-Shyan
  • Liu, Tsai-Ching
  • Chen, Bradley
  • Lin, Chung-Liang

Abstract

Two policy interventions in Taiwan aiming to slow the growth of cesarean delivery utilization were respectively implemented in 2005 and 2006. The first policy provided financial incentives to encourage vaginal delivery by setting a global fee for obstetric services and in essence increasing the reimbursement for vaginal delivery up to the same level of cesarean section. The second policy aimed to reduce the demand for elective cesarean procedure by employing a copayment when cesarean section is not medically indicated. This paper examines the impact of financial incentives of both the supply and the demand side on the use of utilization of cesarean section using data from the 2003–2008 National Health Insurance Research Database. We found that while the overall trend of cesarean utilization did not seem to respond to the interventions, the policies did have significant impact on its elective use. Financial incentives for the providers do matter, and policy interventions, such as a fee change, are still important strategies to consider in reducing the over-utilization of cesarean section.

Suggested Citation

  • Chen, Chin-Shyan & Liu, Tsai-Ching & Chen, Bradley & Lin, Chung-Liang, 2014. "The failure of financial incentive? The seemingly inexorable rise of cesarean section," Social Science & Medicine, Elsevier, vol. 101(C), pages 47-51.
    • Handle: RePEc:eee:socmed:v:101:y:2014:i:c:p:47-51
    DOI: 10.1016/j.socscimed.2013.11.010
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    References listed on IDEAS

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    1. Lobel, Marci & DeLuca, Robyn Stein, 2007. "Psychosocial sequelae of cesarean delivery: Review and analysis of their causes and implications," Social Science & Medicine, Elsevier, vol. 64(11), pages 2272-2284, June.
    2. Grant, Darren, 2009. "Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project," Journal of Health Economics, Elsevier, vol. 28(1), pages 244-250, January.
    3. Chen, Chin-Shyan & Liu, Tsai-Ching & Chen, Li-Mei, 2003. "National Health Insurance and the antenatal care use: a case in Taiwan," Health Policy, Elsevier, vol. 64(1), pages 99-112, April.
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    1. Bhatia, M. & Dwivedi, L.K. & Banerjee, K. & Dixit, P., 2020. "An epidemic of avoidable caesarean deliveries in the private sector in India: Is physician-induced demand at play?," Social Science & Medicine, Elsevier, vol. 265(C).
    2. Berta, P.; & Martini, G.; & Piacenza, M.; & Turati, G.;, 2019. "The strange case of appropriate C-sections:DRG-tariff regulation, hospital ownership, and market concentration," Health, Econometrics and Data Group (HEDG) Working Papers 19/02, HEDG, c/o Department of Economics, University of York.
    3. Yushan Yu & Xiangyang Zhang & Caixia Sun & Huijie Zhou & Qi Zhang & Chun Chen, 2017. "Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou, China," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-12, November.
    4. El-Shal, Amira & Cubi-Molla, Patricia & Jofre-Bonet, Mireia, 2021. "Are user fees in health care always evil? Evidence from family planning, maternal, and child health services," Economic Analysis and Policy, Elsevier, vol. 72(C), pages 506-529.
    5. Paolo Berta & Gianmaria Martini & Massimiliano Piacenza & Gilberto Turati, 2020. "The strange case of less C‐sections: Hospital ownership, market concentration, and DRG‐tariff regulation," Health Economics, John Wiley & Sons, Ltd., vol. 29(S1), pages 30-46, October.

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