實施“前胎剖腹產之陰道生產”論病例計酬對醫師執行剖腹產後自然產之影響

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＜0.001). Logistic regression analysis showed that implementation of VBAC case payments and major clinical diagnoses were significant predictors of physicians practicing VBAC. Conclusions: The results of the current study indicate that after implementation of the VBAC case payment initiative, physicians demonstrated an increased tendency to offer VBAC. Thus, financial incentives exert an impact on a physician's practice behavior.