Impact of case payment on physicians practicing vaginal birth after cesarean section

Ya Hui Tsai, Kuo Cherh Huang, Yung Kuei Soong

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Objectives: To reduce the cesarean delivery rate, Taiwan's Bureau of National Health Insurance (BNHI) introduced the "Vaginal Birth after Cesarean Section" (VBAC) case payment program on April 1, 2003. The purpose of the current study was to determine the impact of case payment on physicians practicing VBAC. Methods: The data used in the study were derived from the health care system in Taiwan, including four of the system's hospitals, 30 obstetric attendings, and 2,246 gravidas with a previous cesarean section delivery under the attending physician's care. A paired t-test was used to analyze the VBAC rate before and after the introduction of the VBAC case payment initiative. Logistic regression analysis was then performed to determine the relationship between VBAC case payment and the likelihood of physicians practicing VBAC, controlling for related variables, such as previous cesarean section delivery of the sample gravidas. Results: After implementation of VBAC case payments, the VBAC rates at the sampled hospitals increased 6.06% (p

Original languageEnglish
Pages (from-to)283-292
Number of pages10
JournalTaiwan Journal of Public Health
Issue number4
Publication statusPublished - Aug 2006


  • Case payment
  • Vaginal birth after cesarean section

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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