Vaginal birth after cesarean: a reward/penalty system for national implementation.

Abstract

The advantages of vaginal birth in properly selected patients with previous cesarean delivery have been amply demonstrated. Curiously, however, the present payment system pays both physician and hospital more for repeat cesarean than for vaginal birth. To correct this, I propose an incentive system in which a doctor is paid more for vaginal than cesarean birth (a reward) and the patient assumes financial responsibility for hospital costs beyond those of vaginal birth (a penalty).