| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 94 === Abstract
Bureau of National Health Insurance revised the payment scheme on delivery case on May 2005. So the aim of thesis is try to discuss the impact of the payment advanced on normal delivery and the influences of CS (cesarean section) rate. The study subjects involved 329824 obstetric cases from BNHI in Taiwan and the period was mainly from May 2004 to Dec 2005. We divided the study period into two parts. One is payment revised before and after (Sep 2004~Apr 2005 v.s. May 2005~Dec 2005), another is we compare the same period in 2004 and 2005 (May 2004~Dec 2005 v.s. May 2005~Dec 2005).
The results showed as below：
1.The entire CS rate changed unapparent：
After revised the payment, the adjusted rate of CS is 32.67% a little greater than before (32.26%). And it was also greater than the same period (32.49%) slightly in 2004. CS rate was not reduced with raising the payment on normal delivery.
2.The first-time CS rate changed unapparent：
After executing the policy, the adjusted rate for first-time CS is 23.27%. It also rises a little compared with before (22.71%). It was in the same situation (32.49%) in 2004. The first-time CS rate was also not reduced with raising the payment on normal delivery.
3. The influences of CS rate on demand side：
The CS rate will get higher with gravidas’ age and higher than foreigns. They are all statistically significant.
4. The influences of CS rate on supply side：
The characteristic of physicians and hospital are the mainly factors on supply side. We found that CS had served by elder and male physician with higher probability. In geographically, the Eastern Region Branch and the remote areas has lower CS rate in Taiwan. They are all statistically significant.
With the results, We proposed the suggestions below：
1. For Bureau of National Health Insurance
a Try to adjust the payment scheme on obstetric. To encourage the institutions of healthcare of true implement the health education to parturient women and their family by paying a certain amount for healthcare.
b As the policy implementation, it should be go with properly accompanying measure. For example, voluntarily to request the cesarean to be supposed to pay the price difference. Or to restore the specialized review measure and only to pay the previous point for those are not conform the indication for CS.
2. For administrative organizations of health：
To establish the evidence based guide to cesarean by associations or experts and to publicize it properly through media. At the same time promoting health education regarding parturient women, shaping ideas among the public, especially parturient women to lower percentage of cesarean delivery owing to non-medical factors, and further control cesarean delivery rate.
3. For medical supply side：
To develop the course of treatment on obstetric.
a Strengthens of health education of parturient women and their family members.
b It would be helpful for reducing the CS rate to strengthen of the training for obstetricians to operate the equipments correctly and realize the normal procedure of delivery. Besides, take medical disputes insure for physicians or change the salary scale for those do normal delivery also could be the way to reduce CS rate.
4. Suggestion for future investigation：
This study only observed eight months the policy implementation before and after, we suggest that it would be more objective to observe the CS rate in long term study. In addition to, it would be helpful for future research to discuss the impact factors of physicians’ behavior by doing survey as payment adjusted.
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