• Dorthe Fuglenes, Pål Oian, Dorte Gyrd-Hansen, Jan Abel Olsen, and Ivar S Kristiansen.
• Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Norway. dorthe.fuglenes@medisin.uio.no
• Acta Obstet Gynecol Scand. 2010 Dec 1;89(12):1582-8.

Objectiveto explore obstetricians' opinions on cesarean section (CS) on maternal request in the absence of a medical indication, and the potential to regulate CS on maternal request through financial incentives such as patient co-payment.Designcross-sectional study.SettingNorway.Population/Samplea total of 507 obstetricians (response rate 71%).MethodsQuestionnaire covering socio-demographic variables, professional experience and attitudes about CS on maternal request (such as willingness to perform, views on how CS on maternal request should be financed).Main Outcome Measuresobstetricians' opinions about CS on maternal request including funding and use of patient co-payments.Resultsclinical encounters with CS on maternal request were considered problematic from a clinical viewpoint by 62% of the respondents. While 35% considered the costs of CS on maternal request to be a public responsibility, 40% suggested use of co-payments ranging from €188- €7,500. Male obstetricians less frequently considered CS on maternal request problematic and were more likely to favor public funding than females. Female obstetricians favored use of co-payments more often than males (64% female vs. 37% male obstetricians, χ(2) = 23.94, p < 0.001) and suggested higher co-payments. The median co-payment was €1,875 for female and €1,250 for male obstetricians (p < 0.001).Conclusionsthe study supports the existence of a gender difference concerning obstetricians' responses to patient requested cesarean section. The results indicate that a substantial proportion of obstetricians welcome some form of constraint concerning cesarean section requests in the absence of a medical indication.

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