The failure of financial incentive? The seemingly inexorable rise of cesarean section

Institutional setting and wealth gradients in cesarean delivery rates: Evidence from six developing countries

“…Differences in physician's remuneration (fee‐for‐service vs salary) was also found to be the main factor behind the widening gap in cesarean rates between public and private hospitals in some settings . However, the traditional distinction between salary and fee‐for‐service is often blurred in the context of many developing countries where informal payments are rampant within public hospitals and/or the income of the staff are related to hospital net revenues through bonus systems, creating incentives for supply‐induced demand for more services and more expensive procedures .…”

Impact of Provider Competition under Global Budgeting on the Use of Cesarean Delivery

“…Moreover, providers earn more revenues with elective cesarean deliveries because they receive copayments in cash from patients and, unlike vaginal deliveries, only part of the actual reimbursements for elective cesarean deliveries is susceptible to price cuts by the point value adjustment (Chen et al. ).…”

“…; Chen et al. ). As there exists determination for cost control across health systems, our investigation on the cesarean delivery rate in the context of noncooperative competition not only can inform policy makers about the potential trade‐offs, but also can shed light on how the rising cesarean delivery rate could be affected by cost containment measures.…”

Colorado Medicaid Hospital Rate Change: The Importance of the Broader Multi- Provider, Multi-Payer Environment

“…Some studies of Medicaid fees to physicians have found that the differential fees for cesarean delivery relative to vaginal delivery have a modest effect on cesarean rates [15][16][17].…”

“…One study of births in Taiwan finds that equal physician payments for vaginal and cesarean delivery reduces the rate of elective cesarean delivery among younger mothers but has no significant impact on the overall cesarean rate [17]. There is some evidence that cesarean rates may be lower in organizational structures that insulate physicians from differential financial rewards.…”