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Non-elective cesarean sections in public hospitals: hospital capacity constraints and doctor´s incentives

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  • Alejandro Arrieta

    (Indiana University School of Medicine Department of Public Health)

  • Ariadna García-Prado

    ()
    (Departamento de Economía-UPNA)

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    Abstract

    Using administrative records of births from the Perinatal Surveillance System of the Social Security System (ESSALUD) in Peru, we test whether high admissions of pregnant women affected unplanned cesarean section rates in the ESSALUD public hospitals during the period 2005-2006. To this purpose, we present a basic theoretical model that considers not only physician preference for leisure but also the effect of hospital capacity constraints. Based on inferences of this model, we find that physician demand for leisure increases the probability of a c-section in the smallest hospitals, while hospital constraints set a limit on the number of cesarean sections that can be performed. We discuss the policy implications of our findings and the policies implemented in ESSALUD to monitor the quality of obstetric services and avoid unnecessary or unjustified c-sections.

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    File URL: ftp://ftp.econ.unavarra.es/pub/DocumentosTrab/DT1212.PDF
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    Bibliographic Info

    Paper provided by Departamento de Economía - Universidad Pública de Navarra in its series Documentos de Trabajo - Lan Gaiak Departamento de Economía - Universidad Pública de Navarra with number 1212.

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    Date of creation: 2012
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    Publication status: Published in
    Handle: RePEc:nav:ecupna:1212

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    Related research

    Keywords: Cesarean sections; public hospitals; leisure; capacity constraints; Perú;

    References

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    1. Sarkis, Joseph, 2000. "A comparative analysis of DEA as a discrete alternative multiple criteria decision tool," European Journal of Operational Research, Elsevier, vol. 123(3), pages 543-557, June.
    2. Evans, William N. & Kim, Beomsoo, 2006. "Patient outcomes when hospitals experience a surge in admissions," Journal of Health Economics, Elsevier, vol. 25(2), pages 365-388, March.
    3. Brown, H. III, 1996. "Physician demand for leisure: implications for cesarean section rates," Journal of Health Economics, Elsevier, vol. 15(2), pages 233-242, April.
    4. Ching-to Albert Ma, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Papers 0047, Boston University - Industry Studies Programme.
    5. Andrew Epstein & Sean Nicholson, 2005. "The Formation And Evolution Of Physician Treatment Styles: An Application To Cesarean Sections," Working Papers id:176, eSocialSciences.
    6. Alejandro Arrieta & Ariadna García Prado & Jorge Guillén, 2009. "The Private Health Care Sector and the Provision of Prenatal Care Services in Latin America," IDB Publications 9335, Inter-American Development Bank.
    7. Patricia Triunfo & Máximo Rossi, 2009. "The effect of physicians’ remuneration system on the Caesarean section rate: the Uruguayan case," International Journal of Health Care Finance and Economics, Springer, vol. 9(4), pages 333-345, December.
    8. Litvak, Nelly & van Rijsbergen, Marleen & Boucherie, Richard J. & van Houdenhoven, Mark, 2008. "Managing the overflow of intensive care patients," European Journal of Operational Research, Elsevier, vol. 185(3), pages 998-1010, March.
    9. Rajiv Sharma & Miron Stano & Renu Gehring, 2008. "Short-term fluctuations in hospital demand: implications for admission, discharge, and discriminatory behavior," RAND Journal of Economics, RAND Corporation, vol. 39(2), pages 586-606.
    10. Daniele Fabbri & Chiara Monfardini, 2006. "Style of practice and assortative mating: a recursive probit analysis of cesarean section scheduling in Italy," CHILD Working Papers wp06_06, CHILD - Centre for Household, Income, Labour and Demographic economics - ITALY.
    11. J Hurley & R Labelle, 1994. "Relative Fees and the Utilization of Physicians' Services in Canada," Centre for Health Economics and Policy Analysis Working Paper Series 1994-06, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    12. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, vol. 18(4), pages 473-490, August.
    13. Dubay, Lisa & Kaestner, Robert & Waidmann, Timothy, 1999. "The impact of malpractice fears on cesarean section rates," Journal of Health Economics, Elsevier, vol. 18(4), pages 491-522, August.
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