National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan

Objectives. Taiwan's National Health Insurance Program (NHI) was implemented on March 1, 1995. This study analyzed the influences of the Case Payment method of reimbursement for inpatient care and of physician financial incentives on a woman's choice for primary cesarean delivery. Methods. Logistic regressions were used to analyze 11788 first-time deliveries in a nonprofit hospital system between March 1, 1994, and February 29, 1996. Results. After implementation of the NHI's Case Payment scheme, the likelihood that a woman would choose primary cesarean delivery, increased by four to five times compared with the choice behavior of uninsured individuals prior to NHI (P<.0001). Conclusion. Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.