The effect of physicians' remuneration system on the Caesarean section rate: the Uruguayan case.

Patricia Triunfo, Máximo Rossi
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引用次数: 20

Abstract

Using data about births from the perinatal information system (PIS) registered in Montevideo (Uruguay), we estimated the probability of having a Caesarian section delivery, controlled by risk factors and the endogeneity of the choice of hospital. In public hospitals in Montevideo there is a fixed payment system, but in private hospitals this procedure has to be paid for separately. In the former, there is no effect on the doctor's income if he performs a Caesarian, but in the latter there is a positive effect. Empirical evidence shows the probability of a Caesarean section increases with the age of the woman, the presence of eclampsy, pre-eclampsy, previous hypertension, previous Caesarean sections, multiple pregnancies and fetopelvic disproportion, and decreases for multiparous women and women in a public hospital. In fact, the probability of having a Caesarean section in a private institution is almost two times higher than in a public hospital (20% as against 39%). Focusing on women without risk factors, we found that the probability a Caesarian in a public hospital was 11%, but the probability in a private hospital was 25%. We conclude that the remuneration system explains an important part of this difference.

医生薪酬制度对剖宫产率的影响:乌拉圭案例。
利用在蒙得维的亚(乌拉圭)登记的围产期信息系统(PIS)的出生数据,我们估计了在风险因素和医院选择的内生性控制下剖腹产分娩的概率。在蒙得维的亚的公立医院有固定的支付系统,但在私立医院,这一程序必须单独支付。在前一种情况下,如果医生实施剖腹产手术,对医生的收入没有影响,但在后一种情况下,对医生的收入有积极影响。经验证据表明,剖腹产的可能性随着妇女的年龄、是否患有子痫、先兆子痫、既往高血压、既往剖腹产、多胎妊娠和胎盆腔比例失调而增加,而对于多胎妇女和公立医院的妇女则减少。事实上,在私立医院进行剖腹产的可能性几乎是公立医院的两倍(20%对39%)。关注没有危险因素的妇女,我们发现在公立医院剖腹产的概率为11%,而在私立医院剖腹产的概率为25%。我们的结论是,薪酬制度解释了这种差异的一个重要部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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