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研究生:陳進典
研究生(外文):Gin-Den Chen
論文名稱:台灣剖腹產率的區域性差異、醫師剖腹產率的影響因素及剖腹產率與嬰兒初次周產期住院率的相關性
論文名稱(外文):Area Variations of Cesarean Section Rates, Factors Influencing Physician’s Cesarean Section Rates and Association between Cesarean Section Rates and Perinatal Morbidity
指導教授:鄭守夏鄭守夏引用關係
指導教授(外文):Shou-Hsia Cheng
口試委員:何弘能蔡憶文許玫玲楊銘欽
口試委員(外文):Hong-Nerng HoYi-Wen TsaiMei-Ling SheuMing-Chin Yang
口試日期:2015-05-18
學位類別:博士
校院名稱:國立臺灣大學
系所名稱:健康政策與管理研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:117
中文關鍵詞:剖腹產率區域性差異醫師剖腹產率周產期住院率
外文關鍵詞:cesarean section ratesarea variationsperinatal morbidityphysician''s cesarean section rates
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過去20 年裡,大部分學者對於台灣剖腹產率的研究都使用個人層級的資料,探討非臨床相關因素與總體剖腹產率的關係。本研究以健保分局轄區、院所和醫師為分析單位,探討下列三個研究主題:一、探討不同分局轄區的剖腹產率差異和剖腹產適應症的變化趨勢,二、評估醫師和醫院層級的因素對醫師剖腹產率的影響,三、找出院所剖腹產率與院所內新生兒周產期住院率是否相關。
先以1998 到2010 年的全國住院資料檔案的住院費用清單明細檔 (in-patientexpenditures by admissions, DD),進行先驅型的分析之後,三個主題都使用1998、2002、2006 和2010 年等四個年度的年度生產資料特殊需求檔進行分析。此特殊需求檔包括醫事機構基本資料檔(HOSB)、醫事人員基本資料檔PER)、住院費用清單明細檔(DD)、住院醫療費用醫令清單明細檔(DO)、門診處方及治療明細檔(CD)和門診處方醫令明細檔(OO)等,由資料庫裡的處置代碼整理出不同的生產方式。剖腹產率的計算方式是以年度剖腹產數除以全年度的活產數(申報資料裡的剖腹產加陰道產),計算出台灣總體、分局轄區、院所和醫師的年度剖腹產率。第三個主題裡加入2002、2006 和2010 年由全國住院資料檔案的住院費用清單明
細檔計算出的院所內新生兒周產期住院數資料,將此資料串回前述的2002、2006和2010 年特殊需求檔之後,算出院所的新生兒周產期住院率,進行分析。主題一的結果顯示,不同分局轄區的最高與最低的剖腹產率差距:1998 年是9.53%、2002 年是12.5%、2006 年是8.44%和2010 年是10.84%。此結果代表以最低剖腹產率的分局轄區為基準時,最高分局轄區年度剖腹產率是最低分局轄區年度剖腹產率的1.29 至1.46 倍。而剖腹產適應症在各分局的分布情形也有顯著的差異,這四個年度裡主觀性剖腹產適應症無顯著的變化,再次剖腹產率逐漸的下降;但是胎位不正呈異常且顯著的升高趨勢,2006 和2010 年高危險妊娠適應症在分局轄區和院所層級也顯著且無法解釋的升高。 主題二的結果發現,控制了醫師和院所層級的因素之後,較低年服務量的醫師剖腹產率顯著的比高年服II務量的醫師高( 年接生數少於104 者的迴歸係數是0.0224, 95% CI:0.0051~0.0434, p =0.0363; 年接生數介於105 至363 者的迴歸係數是0.0234, 95%CI: 0.0051~0.04175, p=0.0122);院所的特約別和院所對剖腹產的偏好扮演著影響該院所醫師剖腹產率的角色,相對於低剖腹產變異程度的院所的醫師,在中度和高度變異程度院所的醫師剖腹產率迴歸係數各為:0.026 和 0.0332 (95% C.I.:0.0068~0.0452, p=0.00781; 95% C.I.:0.0069~0.0595, p=0.0135)。 主題三的結果指出,在控制院所內的剖腹產適應症和高齡產婦的比例之後,院所的剖腹產率愈高者,該院所內出生嬰兒的初次周產期住院率也愈高(β= 0.21797, p=0.0221)。
本研究得到三個主要結論:台灣各健保分局轄區的剖腹產率有極大的差異,但只要能監控剖腹產適應症的不實申報(up-coding or code creep),即可將台灣的剖腹產率降低至32%以下;醫師的剖腹產率主要是受到醫師產科的服務量、院所的特約別和院所對剖腹產的偏好所影響;高的院所剖腹產率與高的院所內新生兒初次周產期住院率有關,高剖腹產率確實會造成較高新生兒周產期的負外部效應。


In the past two decades, most investigators have focused on overall CSRs and have used individual level data to demonstrate non-clinical associated factors of the CSR. The units of analysis in this study focused on branches of the National Health Insurance, institutions and physicians. Aims of this study were: 1. Evaluate variations in CSRs at different NHI branches and changes of indications for cesarean section; 2. Investigate factors influencing physicians’ CSRs from the physician and institutional levels; and 3. Investigate relationships between CSRs and perinatal morbidity in the, institutions.
The in-patient expenditures by admissions (DD) for other research usage were employed to confirm the trend of CSRs from 1998 to 2010 in a pilot study. The specific subject datasets for annual childbirth in Taiwan were used throughout these three areas of research. This dataset includes registry for contracted medical facilities (HOSB), registry for medical personnel (PER), inpatient expenditures by admissions (DD), details of inpatient orders (DO), ambulatory care expenditures by visits (CD) and details of ambulatory care orders (OO). The order codes in the NHI claim data were used to determine modes of delivery. The operational definition of CSR was annual cesarean delivery divided by all annual live births (claims of live births by cesarean delivery and vaginal delivery) in Taiwan, for each branch, institution and physician. In the third subject area, the in-patient expenditures by admissions (DD) in 2002, 2006 and 2010 were joined with the specific subject datasets for annual childbirth and were used to determine the perinatal admission rate in each institution.
In the first subject area, the differences in CSRs between the highest and lowest branch were 9.53% in 1998, 12.5% in 2002, 8.44% in 2006 and 10.84% in 2010.
These findings revealed that the CSR in the highest branch was ranging from 129.16% to 146.52% of the CSR in the lowest branch. Distributions of indications for cesarean section in different branches were divergent. Subjective indications such as failure to progress in labor and fetal distress fluctuated only slightly in these four years. Previous cesarean sections gradually decreased. However, malpresentation and malposition increased significantly. High risk indications increased in 2006 at the NHI branch and institutional levels as well as in 2010. In the second subject area, physicians with lower volume of services performed significantly more cesarean sections than their counterparts with high volume of services when controlling institutional factors (0.0237, 95% CI: 0.0041~0.0434, p =0.018 for less than 104 per year; 0.0252, 95% CI: 0.0075~0.0429, p=0.0053 for ≧104-<364 per year). Institutional factors such as policy or preference in institutions (0.026, 95% C.I.:0.0068~0.0452, p=0.00781 for the institutions with medium variation in cesarean section ratios; 0.0332, 95% C.I.: 0.0069~0.0595, p=0.0135 for the institutions with high variation in cesarean section ratios) and accreditation level, not ownerships, played an important role in influencing the physician’s choice of mode of delivery. In the third subject area, higher institutional CSRs correlated to higher institutional perinatal admission rates for respiratory distress syndrome or other respiratory conditions, such as intrauterine hypoxia and birth asphyxia or infections of the fetus and newborn after controlling indications for cesarean section and proportion of older women(≧35 years old) in institutions (β= 0.21797, p=0.0221).
This study showed that variations of CSRs in the NHI branches did exist and the CSRs in Taiwan would be less than 32% if the NHI bureau could control up-coding or code creep by institutions or physicians. Physicians’ CSRs were influenced by institutional policy or preference for modes of delivery and accreditation level as well as service volume of physicians. Higher CSRs could result in a negative externality in prenatal newborns.

口試委員審定書
誌謝
中文摘要 Ⅰ
英文摘要 Ⅲ
第一章 緒論 1
第一節 研究背景 1
第二節 剖腹產率上升與剖腹產適應症的變化 3
第三節 研究目的 6
第四節 研究問題與研究的重要性 8
第五節 研究主題與寫作的次序 9
第二章 理論的應用與文獻探討 10
第一節 生產方式的效用函數 10
第二節 醫療照護的區域性差異 13
第三節 國外剖腹產研究的文獻探討 17
第四節 台灣剖腹產研究的文獻探討 32
第五節 知識缺口 36
第三章 主題一、台灣剖腹產率的區域性差異與剖腹產適應症的變化 38
緒論 38
材料與方法 42
結果 45
討論 56
結論 61
第四章 主題二、院所因素對醫師選擇生產方式的影響 62
緒論 62
材料與方法 67
結果 69
討論 78
結論 83
第五章 主題三、剖腹產率與嬰兒初次周產期住院率的相關性 84
緒論 84
材料與方法 86
結果 88
討論 95
結論 97
第六章 總結與政策建議 98
參考文獻 100
附錄 109

中文文獻
韓幸紋和連賢明 加倍自然產支付能否降低剖腹產比例? 台灣衛誌2011;29: 218-227.
羅紀琼和劉素芬院所競爭對醫療處置的影響- 以剖腹產為例 臺灣衛誌2004; 23: 71-79.
http://www.nhi.gov.tw/resource/Webdata/24201_1_ 行政院衛生署中程施政計畫(102 至105 年度).doc 2014 年8 月下載。
毛慶生、朱敬一、林全、許松根、陳昭南、陳添枝、黃朝熙合著,經濟學 華泰文化事業有限公司,1998 年5 月出版,第24 章 長期經濟成長, page 531-534)。
張清溪、許嘉棟、劉鶯釧、吳聰敏合著, 經濟學- 理論與實際 五版上冊 翰蘆出版有限公司 2004 年8 月。
許義忠著, 財政學 五南圖書出版公司 2004 年6 月。
朱榮徵編著, 個體經濟學- 實用寶典 全華科技圖書股份有限公司 2004 年5 月。
楊政學編著, 個體經濟學原理 新文京開發出版股份有限公司 2006 年5 月。
楊政學著, 個體經濟學-學理與應用 新文京開發出版股份有限公司 2005 年6 月。
2006 年 新增及修正「全民健康保險醫療費用支付標準」部分診療項目,網址:
http://www.nhi.gov.tw/information/bbs_detail.asp?bulletin_ID=596&menu=1 2014
年8 月下載。

英文文獻
ACOG committee opinion no. 559: Cesarean delivery on maternal request. Obstet Gynecol 2013; 121: 904-907.
Al-Muftir R, McCarthy A, Fisk NM. Survey of obstetrician’s personal preferences and discretionary practice. Eur J Obstet Gynecol Reprod Biol 1997; 73: 1-4.
AMA 2013 www.ama-assn.org/go/healthcarecosts. Accessed on 201312/30.
American College of Obstetricuans and Gynecologists. Surgery and patient choice. In: Ethics in obstetrics and gynecology. 2nd edition. Washington, DC: The American College of Obstetricians and Gynecologists; 2004.
Anderson GM and Lomas J. Explaining variations in cesarean section rates: Patients, facilities or policies? Canadian Medical Association Journal 1985;132: 253-259.
Anderson GM. Making sense of rising cesarean section rates- Time to change our goals. BMJ 2004; 329: 696-697.
Arrow KJ. Uncertainty and the welfare economics of medical care, The American Economic review 1963;53 :941-973.
Belizan JM, Althabe F,Barros FC, Alexander S. Rates and implications of cesarean sections in Latin America: ecological study. BMJ 1999; 319: 1397-1402.
Betran AP, Merialdi M, Lauer JA, Wang BS, Thomas J, van Look P, Wagner M. Rates of cesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007; 21: 98-113.
Black C, Kaye JA, Jick H. Cesarean delivery in the United Kingdom- Time trends in
the general practice research database. Obstet Gynecol 2005; 106: 151-155.
Brown HSⅢ. Physician demand for leisure: Implications for cesarean section rates.
1996; 15:233-242.
Burns LR, Geller SE, Wholey DR. The effect of physician factors on the cesarean section decision Med Care 1995; 33: 365-382.
Cai WW, Marks JS, Chen CH, Zhuang YX, Morris L, Harris JR. Increased Cesarean Section Rates and Emerging Patterns of Health Insurance in Shanghai, China. Am J Public Health. 1998; 88: 777-780.
Centers for Disease Control. Rates of cesarean section delivery: United States, 1991. MMWR 1993; 42: 285-289.
Cesarean section- Indications ACOG Practice Guidelines, up to date 2007.
ChailletN, Dumont A, Abrahamowicz M, Pasquier JC, Audibert F, Monnier P, Abenhaim HA, Dube E, Dugas M, Burne R, Fraser WD, for the QUARISMA Trial Research Group. A cluster-randomized trial to reduce cesarean delivery rates in Quebec. N Engl J Med 2015; 372: 1710-1721.
Chen CS, Lin HC, L iu TC, Lin SY, Pfeiffer S. Urbanization and the likelihood of a cesarean section. Eur J Obstet Gynecol Reprod Biol 2008; 141: 104-110.
Cheng SH and Chiang TL. The effect of universal health insurance on health care utilization in Taiwan- Results from a natural experiment. JAMA 1997; 278: 89-93.
Cibils LA. On intrapartum fetal monitoring. 1996, Am J Obstet Gynecol 1996;174:1382-1389.
Coco AS, Gates TJ, Gallagher ME, Horst MA. Association of Attending Physician Specialty With the Cesarean Delivery Rate in the Same Patient Population. Fam Med 2000; 32: 639-644.
Currie J and Gruber J. Public health insurance and Medical treatment: the equalizing impact of the Medicaid expansions. Journal of Public Economics 2001; 82: 63-89.
de Jong, J. D. (2008). Explaining medical practice variation: Social organization and institutional mechanism. Utrecht: Nivel. Dubay L, Kaestner R, Waidmann T. The impact of malpractice fears on cesarean sections rates. J Health Economics. 1999; 18:491-522.
Ecker JL, Chen KT, Cohen AP, Rilley LE, Lieberman ES. Increased risk of cesarean delivery with advancing maternal age: indications and associated factors in nulliparous women. Am J Obstet Gynecol 2001; 185: 883-887.
Ecker J. Elective cesarean delivery on maternal request. JAMA 2013; 309: 930-1936.
Eddy DM. Variations in physician practice: the role of uncertainty. Health Affairs 1984; 3:74‐89.
Epstein AJ, Nicholson S. The formation and evolution of physician treatment styles: An application to cesarean sections. Journal of Health Economics 2009;28:1126-1140.
Escarce J, Jain A, Rogowski J. Hospital competition, managed care, and mortality after hospitalization for medical conditions: Evidence from three states. Working Paper 12335. NBER 2006.
Essentials of game theory- A concise Multidisciplinary introduction. Kevin Leyton-Brown and Yoav Shoham. 2008 by Morgan & Claypool Publishers。 ISBN: 978159829548 ebook.
Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 1990; 76: 750-754.
Francome C and Savage W. Cesarean section in Britain and the United States 12% or 24%: is either the right rate? Soc Sci Med 1993; 37: 1199-1218.
Freidson E. Profession of medicine: a study of the sociology of applied knowledge. New York: Dodd, Mead & Company, 1975, eight printing
Fu JC, Xirasagar S, Liu J, Probst JC. Cesarean and VBAC rates among immigrant vs. native-born women: a retrospective observational study from Taiwan cesarean
delivery and VBAC among immigrant women in Taiwan. BMC Public Health 2010; 10:548-556.
Gamble JA, Health M, Creedy DK. Women’s preference for a cesarean section: incidence and associated factor. Birth 2001; 28: 101-110.
Geweke J, Gowrisankaran G, Town R. Bayesian inference for hospital quality in a selection model. Econmetrica 2003;71: 1215-1238.
Gibbin L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. The global numers and costs of additional needed and unnecessary cesarean sections performed per year: overuse as barrier to universal convergence. World Health Report (2010),
Background paper, 30.
Gould JB, Davey B Stafford RS. Socioeonomic differences in rates of cesarean section. N Engl J Med 1989; 321: 233-239.
Graham WJ, Hundley V, McCheyne AL, Hall MH, Gurney E, Milne J. An investigation of women’s involvement in the decision to deliver by cesarean section. Br J Obstet Gynecol. 1999; 106:213-220.
Grant D. Explaining source of payment differences in U.S. cesarean rates: Why do privately insured mothers receive more cesareans than mothers who are not privately insured? Health Care Management Science 2005;8: 5-17.
Gruber J and Owings M. Physician financial incentives and cesarean section delivery. RAND journal of Economics 1996; 27: 99-123.
Gruber J, Kim J, Mayzlin D. Physician fees and procedure intensity: the case of cesarean delivery. Journal of Health Economics 1999; 18:473-490.
Guihard P and Blondel B. Trends in risk factors for caesarean section in France between 1981 and 1995: lessons for reducing the rates in the future. Br J Obstet Gynecol 2001; 108: 48-55.
Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or cesarean delivery. BJOG 2013; 120: 144-151.
Health at a Glance 2011: OECD Indicators. Excel files downloaded from: http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/09/index.html?itemId=/content/chapter/health_glance-2011-37-en, accessed April 10th, 2014.
Huang CC, Li CY, Yang CH. Cultural imlications of differing rates of medically indicated and elective cesarean delivies for foreign-born versus native-born Taiwanese
mothers. Matern Child Health J 2012; 16: 1008-1014.
Issues in Obstetrics and Gynecology by The FIGO committee for the Ethical Aspects of Human Reproduction and Women’s Health. (1998), 2003. Available at http://www.figo.org/docs/Ethics%20Guidelines.
Keeler EB and Brodie M. Economic incentives in the choice between vaginal delivery and cesarean section. The Milbank Quarterly 1993; 71:365-404.
Keeler EB and Fok T. Equalizing Physician Fees Had Little Effect on Cesarean Rates. Medical Care Research and Review 1996;53:465-471.
Klein MC. Quick fix culture: The cesarean-section-on-demand debate. Birth 2004;31:161-164.
Klein MC. Cesarean section on maternal request: A societal and professional failure
and symptom of a much larger problem. Birth 2012; 39: 305-310.
Kolas T, Daltveit AK, Nilsen ST, Henriksen T, Hager R, Ingemarsson I, Oian P. Indications for cesarean deliveries in Norway. Am J Obstet Gynecol 2003; 188: 864-870.
Kozak L. Surgical and nonsurgical procedures associated with hospital delivery in the United States: 1980-1987. Birth 1989;16: 209-213.
Kozhimannil KB, Hung P, Prasad S, Casey M, Moscovice I. Rural-urban differences in Obstetric care, 2002-2010, and implications for the future. Med Care 2014; 52:4-9.
Lauer JA, Betran AP, Meriadi M, Wojdyla D. Determinats of cesarean section rates in developed countries: Supply, demand and opportunities for control. World Health Report (2010) Background Paper, No 29.
Lee SI, Khang YH, Lee MS. Women’s attitudes toward mode of delivery in South Korea – a society with high cesarean section rates. Birth 2004; 31: 108-116
Lee SI, Khang YH, Yun A, Jo MW. Rising rates, changing relationships: cesarean section and its correlates in South Korea, 1988-2000. Br J Obstet Gynecol 2005; 112: 810-819.
Lin HC and Xirasagar S. Institutional Factors in Cesarean Delivery Rates : Policy and Research implications. Obstet Gynecol 2004; 103:128-136.
Lin HC and Xirasagar S. Maternal age and the likelihood of a maternal request for cesarean delivery: A 5-year population-based study. Am J Obstet Gynecol 2005;192:848-855.
Liu CY, Hung YT, Chung YL, Chen YJ, Weng WS, Liu JS, Liang KY. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manage 2006; 4:1-22. (in Chinese)
Liu TC, Chen CS, Lin HC. Does elective cesarean section increase utilization of postpartum maternal medical care. Medical care 2008; 46: 440-443.
Liu TC, Lin HC, Chen CS, Lee HC. Obstetrician gender and the likelihood of performing a maternal request for a cesarean delivery, Eur J Obstet Gynecol Reproduct Biol 2008;136:46-52.
Liu TC, Loh CPA, Lin CL, Chen CS. Do cesarean deliveries on maternal request lead to greater maternal care utilization. Health Policy 2014; 117:39-47.
Lo JC. Patients’ attitudes vs. physicians’ determination: implications for cesarean sections. Social science and Medicine 2003; 57: 91-96.
Lo JC and Liu SF. Impact of provider competition on the medical treatment- using cesarean section as an example. Taiwan J Public Health 2004; 23: 71-79.
Lo JC. Finacial incentives do not work- An example of cesarean sections in Taiwan. Health Policy 2008; 88: 121-129.
Localio AR, Lawther AG, Bengston JM, Hebert LE, Weaver SL, Brennan TA, Landis JR. Relationship between malpractice claims and cesarean delivery. Journal of the American Medical Association. 1993; 269: 366-373.
Ma KZ, Norton EC, Lee SY. Declining Fertility and the Use of Cesarean Delivery: Evidence from a Population-Based Study in Taiwan, Health Services Research 2010;45:1360-1375
Ma KZ, Norton EC, Lee SY. Mind the information gap: fertility rate and use of cesarean delivery and tocolytic hospitalizations in Taiwan, Health Economics Review 2011 Dec 12;1(1):20. doi: 10.1186/2191-1991-1-20.
MacDorman MF, Menacker F, Declercq E. Cesarean Birth in the United States: Epidemiology, trends, and outcomes. Clin Perinatol 2008; 35: 293-30.
McPherson K, Wennberg JE, Hovind OB, Clifford P. Small-area variations in the use of common surgical procedures: An international comparison of New England, and Norway.vN Engl J Med 1982;307:1310-1314.
McGuire TG and Pauly MV. Physician response to fee changes with multiple payers, Journal of Health Economics 1991;10:385-410
McMahon MJ, Luther ER, Bowes WA Jr, Olshan AE. Comparison of a trial of labor with an elective second cesarean section. N Engl J Med 1996; 335: 689-695.
Menacker F, Declercq E, MacDorman MF. Cesarean Birth in the United States: Background, trends, epidemiology. Seminars in Perinatology 2006; 30: 235-241.
Minkoff H and Chervenak FA. Elective primary cesarean section. N Engl J Med 2003; 348: 946-950.
Mitler LK, Rizzo JA, Horwitz SM. Physician gender and cesarean sections. Journal of Clinical Epidemiology 2000; 53: 1030-1035
Murray SF. Relation between private health insurance and high rates of cesarean section in Chile: qualitative and quantitative study. Br Med J 2000; 321:1501-1505.
National Institutes of Health. Cesarean delivery on maternal request: NIH consensus and state-of-the-science conference statement. 2006;23:1-29. Available from: http://_consensus.nih.gov/2006/cesareanstatement.pdf.
National Center for Health Statistics, Curtin SC. Rates of cesarean birth and vaginal birth after previous cesarean, 1991-1995. Mon Vit Syat Rep 1997; 45: Suppl 3.
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006;295:1549-1555.
Pauly M and Satterthwaite M. The pricing of primary care physician’s service: A test of the role of consumer information. Bell Journal of Economics 1981; 12: 488-506.
Placek PJ and Taffel SM. Trends in Cesarean section rates for the United States, 1970-1978. Public Health Reports 1980; 95: 540-548.
Robinson J and Luft H. The impact of hospital market structure on patient volume, the average length of stay, and cost of care. Journal of Health Economics 1985; 4: 333-356.
Sachs BP, Kolelin C, Castro MA, Frigoletto F. The risks of lowering the cesarean delivery rate. N Engl J Med 1999; 340: 54-57.
Sakala C. Medically unnecessary cesarean section births: introduction to a symposium. Soc Sci Med 1993; 37: 1177-1198.
Satterthwaite M. Consumer information, equilibrium industry price, and the number of sellers. Bell Journal of Economics 1979;21:19-41.
Shearer EL. Cesarean section: medical benefits and costs. Soc Sci Med 1993; 37: 1223-1231.
Singer B. Elective cesarean sections gaining acceptance. CMAJ 2004; 170: 775.
Spetz J, Smith MW, Ennis SF. Physician Incentives and the Timing of Cesarean
Sections: Evidence from California. Medical Care 2001; 39: 536-550.
Stafford RS. Cesarean section use and source of payment: An analysis of California
hospital discharge abstracts. Am J Public Health 1990;80:313-315.
Stanton CK and Holtz SA. Levels and trends in cesarean birth in the developing world. Stud Fam Plan 2006; 37: 41-48.
Steptz J, Smith MW, Ennis SF. Physician incentives and the timing of cesarean
sections: evidence from California. Med Care 2011; 39: 536-550.
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Ana-sphincter disruption during vaginal delivery. N Engl J Med 1993; 329: 1905-1911.
Taffel et al. Trends in the United States CS rate and reasons for the 1980-85 rise. Am J
Public Health 1987; 77: 955-959.
Taffel SM, Placek PJ, Moien M. 1998 U.S. cesarean section rates at 24.7 per 100 births: aplateau? N Engl J Med 1990; 323: 199-200.
Tollanes MC, Thompson JMD, Daltveit AK, Irgens LM. Cesarean section and maternal education; secular trends in Norway, 1967-2004. Acta Obstetricia et Gynecologica 2007; 86: 840-848.
Tsai YW and Hu TW. National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan. Am J Public Health 2002; 92: 1514-1517.
Tussing AD and Wojtowycz MA. The cesarean decision in New York state, 1986- economic and noneconomic aspects. Medical care. 1992; 30: 529-540.
Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A et al. for the WHO global survey on maternal and perinatal health research group. Cesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. The Lancet 2006; 367: 1819-1829.
Wennberg J and Gittelsohn A. Variations in medical care in health care delivery. Science 1973; 182:1102-1108.
Wennberg J and Gittelsohn A. Variations in medical care among small areas. Scientific American 1982; 246:110-111.
Wennberg J, Barnes BA, Zubkoff M. Professional uncertainty and the problem of supplier-induced demand. Soc Sci Med 1982; 16: 811-824.
Westert GP. Variation in use of hospital care. [dissertation] Assen: Van Gorcum, 1992.
Westert GP, Groenewegen PP. Medical practice variations: changing the theoretical approach. Scand J Public Health, 1999; 27:173‐80.
World Health Organization. Appropriate technology for birth. The Lancet 1985;326:436-437.
Xirasagar, Lin HC, Liu TC. Do group practices have lower caesarean rates than solo practice obstetric clinics? Evidence from Taiwan. Oxford University Press 2006;page 319-325.
Zhang J, Liu Y, Meikle S, Zhang J, Sun W, Li Z. Cesarean delivery on maternal request in Southeast China. Obstet Gynecol 2008; 111: 1077-1082.


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