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Variation in cesarean section rates in Sweden - Causes and economic consequences

Author

Listed:
  • Eckerlund, Ingemar

    (Centre for Health Economics)

  • Gerdtham, Ulf-G

    () (Centre of Health Economics)

Abstract

The average cesarean section rate in Sweden more than doubled during the 1970s, and amounted to 12-3 percent in 1983. After that, there was a steady-state for a couple of years and towards the end of the 80s even a small decrease, to 10.9 percent in 1990. In the early 90s, there was a slight tendency towards an increase. Continuously, however, there has been a considerable variation in cesarean section rates among obstetrical departments. The objective of the study was to explain the interdepartmental variation, and to discuss its potential economic consequences. Using data fron The Swedish Medical Birth Registry 1991, we made a cross-sectional study of the cesarean section rate at the departmental level. We identified some 20 determinants, demand- related as well as supply-related, including practice style. A general model including all regressors was specified. After reducing this model, we were able to explain about one third of the variation. We conclude that the large variation in cesarean section rates implies inefficiency, mainly due to overutilization, but perhaps also underutilization. It is difficult to calculate the resulting welfare loss to society, but we made some rough estimations, indicating an additional cost for "unnecessary" cesarean sections of 12-14 million SEK per year.

Suggested Citation

  • Eckerlund, Ingemar & Gerdtham, Ulf-G, 1996. "Variation in cesarean section rates in Sweden - Causes and economic consequences," SSE/EFI Working Paper Series in Economics and Finance 106, Stockholm School of Economics.
  • Handle: RePEc:hhs:hastef:0106
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    References listed on IDEAS

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    1. Folland, Sherman & Stano, Miron, 1989. "Sources of small area variations in the use of medical care," Journal of Health Economics, Elsevier, vol. 8(1), pages 85-107, March.
    2. Dale Tussing, A. & Wojtowycz, Martha A., 1993. "The effect of physician characteristics on clinical behavior: Cesarean section in New York State," Social Science & Medicine, Elsevier, vol. 37(10), pages 1251-1260, November.
    3. Wennberg, John E. & Barnes, Benjamin A. & Zubkoff, Michael, 1982. "Professional uncertainty and the problem of supplier-induced demand," Social Science & Medicine, Elsevier, vol. 16(7), pages 811-824, January.
    4. Blomqvist, Ake, 1991. "The doctor as double agent: Information asymmetry, health insurance, and medical care," Journal of Health Economics, Elsevier, vol. 10(4), pages 411-432.
    5. Charles E. Phelps, 1992. "Diffusion of Information in Medical Care," Journal of Economic Perspectives, American Economic Association, vol. 6(3), pages 23-42, Summer.
    6. Breusch, T S & Pagan, A R, 1979. "A Simple Test for Heteroscedasticity and Random Coefficient Variation," Econometrica, Econometric Society, vol. 47(5), pages 1287-1294, September.
    7. repec:aph:ajpbhl:1990:80:3:313-315_1 is not listed on IDEAS
    8. Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
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    Cited by:

    1. Leonel Muinelo & Máximo Rossi & Patricia Triunfo, 2005. "Comportamiento médico: una aplicación a las cesáreas en el Uruguay," Documentos de Trabajo (working papers) 0605, Department of Economics - dECON.
    2. Patricia Triunfo & Máximo Rossi, 2009. "The effect of physicians’ remuneration system on the Caesarean section rate: the Uruguayan case," International Journal of Health Economics and Management, Springer, vol. 9(4), pages 333-345, December.

    More about this item

    Keywords

    Cesarean section; practice variation; economic consequences; regression analysis;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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