Taiwan’s High Rate of Cesarean Births: Impacts of National Health Insurance and Fetal Gender Preference

Authors

  • Tsai-Ching Liu PhD,

    1. 1Tsai-Ching Liu is a Professor in the Department of Public Finance and a Researcher at the Taipei Municipal Wan Fang Hospital, Taipei, Taiwan; 2Chin-Shyan Chen is a Professor in the Department of Economics, National Taipei University, and a Researcher at the Taipei Municipal Wan Fang Hospital, Taipei, Taiwan; 3Yi-Wen Tsai is an Associate Investigator in the Division of Health Policy Research at the National Health Research Institutes, Taipei, Taiwan; and 4Herng-Ching Lin is an Associate Professor in the School of Health Care Administration at the Taipei Medical University, Taipei, Taiwan.
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  • 1 Chin-Shyan Chen PhD,

    1. 1Tsai-Ching Liu is a Professor in the Department of Public Finance and a Researcher at the Taipei Municipal Wan Fang Hospital, Taipei, Taiwan; 2Chin-Shyan Chen is a Professor in the Department of Economics, National Taipei University, and a Researcher at the Taipei Municipal Wan Fang Hospital, Taipei, Taiwan; 3Yi-Wen Tsai is an Associate Investigator in the Division of Health Policy Research at the National Health Research Institutes, Taipei, Taiwan; and 4Herng-Ching Lin is an Associate Professor in the School of Health Care Administration at the Taipei Medical University, Taipei, Taiwan.
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  • 2 Yi-Wen Tsai PhD,

    1. 1Tsai-Ching Liu is a Professor in the Department of Public Finance and a Researcher at the Taipei Municipal Wan Fang Hospital, Taipei, Taiwan; 2Chin-Shyan Chen is a Professor in the Department of Economics, National Taipei University, and a Researcher at the Taipei Municipal Wan Fang Hospital, Taipei, Taiwan; 3Yi-Wen Tsai is an Associate Investigator in the Division of Health Policy Research at the National Health Research Institutes, Taipei, Taiwan; and 4Herng-Ching Lin is an Associate Professor in the School of Health Care Administration at the Taipei Medical University, Taipei, Taiwan.
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  • and 3 Herng-Ching Lin PhD 4

    Corresponding author
    1. 1Tsai-Ching Liu is a Professor in the Department of Public Finance and a Researcher at the Taipei Municipal Wan Fang Hospital, Taipei, Taiwan; 2Chin-Shyan Chen is a Professor in the Department of Economics, National Taipei University, and a Researcher at the Taipei Municipal Wan Fang Hospital, Taipei, Taiwan; 3Yi-Wen Tsai is an Associate Investigator in the Division of Health Policy Research at the National Health Research Institutes, Taipei, Taiwan; and 4Herng-Ching Lin is an Associate Professor in the School of Health Care Administration at the Taipei Medical University, Taipei, Taiwan.
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  • This research was supported by the National Science Council of R.O.C. (NSC92-2415-H-305-012), Taipei, Taiwan.

Herng-Ching Lin, PhD, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan.

Abstract

ABSTRACT: Background: Taiwan has a high rate of cesarean section, approximately 33 percent in the past decade. This study investigates and discusses 2 possible factors that may encourage the practice, one of which is fetal gender difference and the other is Taiwan’s recently implemented National Health Insurance (NHI). Methods: A logistic regression model was used with the 1989 and 1996 National Maternal and Infant Health Survey and with the 2001 to 2003 NHI Research Databases. Results: Using survey data, we found a statistically significant 0.3 percent gender difference in parental choice for cesarean section. However, no statistically significant difference was found in the rate of cesarean section before and after NHI implementation. Conclusions: Taiwan’s high cesarean section rate is not directly related to financial incentives under NHI, indicating that adjusting policy to lower financial incentives from NHI would have only limited effect. Likewise, focusing effort on the small gender difference is unlikely to have much impact. Effective campaigns by health authorities might be conducted to educate the general population about risks associated with cesarean section and the benefits of vaginal birth to the child, mother, and society. (BIRTH 34:2 June 2007)

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