During our study period, the NHI reimbursement rate for medically indicated c-sections is twice that of a CDMR or a vaginal delivery.
Women who had medically indicated c-sections and CDMR were generally older (29.
We estimated the effect of declining fertility on the use of medically indicated c-sections and CDMR by calculating the marginal effects of the logarithm of GFR and the logarithm of the lagged number of ob/gyns per 100 births in the multinomial probit model (Table 2).
In test 4, we limited our sample to women aged [greater than or equal to] 34 because prior studies indicated that women aged 34 and older were more likely to have CDMR (Lin and Xirasagar 2005).
In robustness test 3 that included only women with primary c-sections and vaginal delivery, the effect of the logarithm of GFR on the probability of having CDMR was greater, corroborating the finding that women preference for c-section increased as a result of the fertility decline.
2005), our study further suggests that a significant share of CDMR can be explained by declining fertility.
As an increasing number of women choose to delay their first delivery in Taiwan, the relative benefits of CDMR may outweigh the risks.
To the extent up-coding exists, the number of CDMR would be under-reported and our estimation of the effect of fertility decline on CDMR would be conservative.