The Impact of Raising Vaginal Delivery Payment on Cesarean-Section Rate – a local teaching hospital in Kaohsiung as an example

• Main Authors: Sz-Chi Hung, 洪思齊
• Other Authors: Yong-Yuan Chang
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/50379801427057723985

碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 96 === Objective: The Bureau of National Health Insurance revised the payment scheme on delivery case on May, 2005. The purpose of the study is to discuss the impact of raising vaginal delivery payment on the Cesarean section (C/S) rate. We also discussed the related factors which affect the C/S rate. Methods: The study subjects involved 2006 obstetric cases from Catholoic St.Joseph hospital in Kaohsiung and the period was from Feb 1st, 2004 to Jul 31st 2006, 30 months totally. We used quasi- experimental design and retrospective chart review. We divided the study period into two parts. One is payment revised before, 1072 obstetric cases from Feb 1st 2004 till April 30th, 2005. The other is after the new payment policy, 934 obstetric cases from May 1st, 2005 till Jul 31st, 2006. We used SPSS12.0 version statistical package for data analysis. We used one-group interrupted time series analysis to discuss if the total C/S rate and primary C/S rate will vary with the policy. We also use multiple logistic regression analysis to compare the related factors affecting C/S rate. Theses factors included the age and nationality of the parturient, the gender of the newborn, the mother if she had private insurance; the age and the loading case of the Obstetrician, full time or part-time Obstetrician and also, the birth timing. Results: During the 30 months and among the 2006 obstetric cases, the Taiwanese were 1865, 92.97% of the total cases and the average age of them were 30.7 (±4.6SD) years old; Chinese 67, 3.33%, 27.1 (±5.1SD) years old; Southeast Asian 62, 3.1%, 23.7 (±3.3SD) years old; and the Caucasian were 12, 0.6%, 30.58 (±4.76SD) years old. There were 1123 vaginal delivery (57.98%) cases, 883 C/S (44.02%) cases and 564 cases received primary C/S (28.12%). The indications of the C/S were previous C/S, prolonged labor, malpresentation and fetal distress and the percentage were: 36.16%, 21.40%, 19.25% and 10.88%, respectively. These four accounted the total 883 C/S cases 87.69%. Before the policy, the vaginal birth after Cesarean (VBAC) rate was 3.21% and 8.0% after the policy. By the observation of time-series analysis, the interruption of the new payment policy didn’t affect the total and primary C/S rate. In the multiple logistic regression and comparing the different independent variables for C/S, the odds ratio of Taiwanese parturient is 2.43 times (p<0.05)than the Southeast Asian ones. As for the age, taking the odds ratio of C/S of the parturient below 20 years old as 1, the age between 35~39 ones was 3.289 times (p<0.05) than it and the parturients aged over 39 years old was 4.289 times (p<0.05) than it. Taking the odds ratio of C/S of the baby’s weight below 3800gm as 1, the weight over 3800gm was 1.487 times (p<0.05) than it. Taking odds ratio of C/S of the birth on weekend as 1, the birth in week day was 1.289 times (p<0.05) than it. Taking the odds ratio of C/S of the birth during non-official hour (5:00~17:00) as 1, the birth during official hour was 3.12 times (p<0.001) than it. Besides, the influence for C/S of the different Obstetrician was non-significant. Conclusion: The raising of the payment for vaginal delivery could not lower the C/S rate. The obstetrician would not tend to choose the higher profit vaginal delivery instead of C/S and the major consideration was safety. The factors of elder maternity, Taiwan nationality, the over- weight baby, the birth on week day and the birth during official hours were predispose to C/S