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Physician Financial Incentives and Cesarean Section Delivery

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  • Jonathan Gruber
  • Maria Owings

Abstract

The 'induced demand' model states that in the face of negative income shocks physicians may exploit their agency relationship with patients by providing excessive care in order to maintain their incomes. We test this model by exploiting an exogenous change in the financial environment facing obstetrician/gynecologists during the 1970s: declining fertility in the U.S. We argue that the 13.5% fall in fertility over the 1970-1982 period increased the income pressure on ob/gyns, and led them to substitute from normal childbirth towards a more highly reimbursed alternative, cesarean delivery. Using a nationally representative micro-data set for this period, we show that there is a strong correlation between within state declines in fertility and within state increases in cesarean utilization. This correlation is robust to consideration of a variety of alternative hypotheses, and appears to be symmetric with respect to periods of fertility decline and fertility increase.

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  • Jonathan Gruber & Maria Owings, 1994. "Physician Financial Incentives and Cesarean Section Delivery," NBER Working Papers 4933, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:4933
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    1. Victor R. Fuchs, 2018. "The Supply of Surgeons and the Demand for Operations," World Scientific Book Chapters, in: Health Economics and Policy Selected Writings by Victor Fuchs, chapter 16, pages 171-192, World Scientific Publishing Co. Pte. Ltd..
    2. Thomas G. McGuire & Mark V. Pauly, 1991. "Physician Response to Fee Changes with Multiple Payers," Papers 0015, Boston University - Industry Studies Programme.
    3. J Hurley & R Labelle & T Rice, 1990. "The Relationship Between Physician Fees and the Utilization of Medical Services in Ontario," Centre for Health Economics and Policy Analysis Working Paper Series 1990-04, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    4. Cromwell, Jerry & Mitchell, Janet B., 1986. "Physician-induced demand for surgery," Journal of Health Economics, Elsevier, vol. 5(4), pages 293-313, December.
    5. Williams, R.L. & Hawes, W.E., 1979. "Cesarean section, fetal monitoring and perinatal mortality in California," American Journal of Public Health, American Public Health Association, vol. 69(9), pages 864-870.
    6. Grytten, Jostein & Holst, Dorthe & Laake, Peter, 1990. "Supplier inducement : Its effect on dental services in Norway," Journal of Health Economics, Elsevier, vol. 9(4), pages 483-491, December.
    7. T Rice & R Labelle, 1989. "Do Physicians Induce Demand for Medical Service?," Centre for Health Economics and Policy Analysis Working Paper Series 18, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    8. Gruber, J., 1992. "The Efficiency of a Group-Specific Mandated Benefit: Evidence from Health Insurance Benefits for Maternity," Working papers 92-19, Massachusetts Institute of Technology (MIT), Department of Economics.
    9. David Bloom & James Trussell, 1984. "What are the determinants of delayed childbearing and permanent childlessness in the United States?," Demography, Springer;Population Association of America (PAA), vol. 21(4), pages 591-611, November.
    10. Goddeeris, John H, 1984. "Medical Insurance, Technological Change, and Welfare," Economic Inquiry, Western Economic Association International, vol. 22(1), pages 56-67, January.
    11. McGuire, Thomas G. & Pauly, Mark V., 1991. "Physician response to fee changes with multiple payers," Journal of Health Economics, Elsevier, vol. 10(4), pages 385-410.
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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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