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More Hospital Choices, More C-sections: Evidence from Chile

Author

Listed:
  • Ramiro de Elejalde

    (Departamento de Economía, Universidad Alberto Hurtado)

  • Eugenio Giolito

    (Departamento de Economía, Universidad Alberto Hurtado, Chile and IZA)

Abstract

In this paper, we study the effect on cesarean rates of a policy change in Chile that decreased the cost of delivery at private hospitals for womenwith public health insurance. Using a difference-in-differences (DID) approach based on the eligibility conditions for this benefit, we find that in the first three years after the policy took effect, deliveries in private hospitals increased by 8.7 percentage points, while the probability of a C-section being performed increased by 4.6 percentage points, with negative impacts on average newborn weight and size at birth. We show that the probability of an early term birth in hospitals participating in the program is an increasing function of expected hospital demand at the time of the full-term due date. This suggests that in the absence of price incentives, hospitals use C-sections to smooth out demand over time to optimize the use of their resources.

Suggested Citation

  • Ramiro de Elejalde & Eugenio Giolito, 2019. "More Hospital Choices, More C-sections: Evidence from Chile," ILADES-UAH Working Papers inv329, Universidad Alberto Hurtado/School of Economics and Business.
    • Handle: RePEc:ila:ilades:inv329
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    References listed on IDEAS

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    1. Patricia K. Foo & Robin S. Lee & Kyna Fong, 2017. "Physician Prices, Hospital Prices, and Treatment Choice in Labor and Delivery," American Journal of Health Economics, University of Chicago Press, vol. 3(3), pages 422-453, Summer.
    2. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    3. Shen, Yu-Chu, 2002. "The effect of hospital ownership choice on patient outcomes after treatment for acute myocardial infarction," Journal of Health Economics, Elsevier, vol. 21(5), pages 901-922, September.
    4. Erin M. Johnson & M. Marit Rehavi, 2016. "Physicians Treating Physicians: Information and Incentives in Childbirth," American Economic Journal: Economic Policy, American Economic Association, vol. 8(1), pages 115-141, February.
    5. Sara Allin & Michael Baker & Maripier Isabelle & Mark Stabile, 2015. "Accounting for the Rise in C-sections: Evidence from Population Level Data," NBER Working Papers 21022, National Bureau of Economic Research, Inc.
    6. Costa-Ramón, Ana María & Rodríguez-González, Ana & Serra-Burriel, Miquel & Campillo-Artero, Carlos, 2018. "It's about time: Cesarean sections and neonatal health," Journal of Health Economics, Elsevier, vol. 59(C), pages 46-59.
    7. Jonathan Gruber & Maria Owings, 1996. "Physician Financial Incentives and Cesarean Section Delivery," RAND Journal of Economics, The RAND Corporation, vol. 27(1), pages 99-123, Spring.
    8. Lien, Hsien-Ming & Chou, Shin-Yi & Liu, Jin-Tan, 2008. "Hospital ownership and performance: Evidence from stroke and cardiac treatment in Taiwan," Journal of Health Economics, Elsevier, vol. 27(5), pages 1208-1223, September.
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    Citations

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    Cited by:

    1. Facchini, Gabriel, 2022. "Low staffing in the maternity ward: Keep calm and call the surgeon," Journal of Economic Behavior & Organization, Elsevier, vol. 197(C), pages 370-394.
    2. Julio Cáceres-Delpiano & Eugenio Giolito, 2023. "Minimum age requirements and the role of the school choice set," SERIEs: Journal of the Spanish Economic Association, Springer;Spanish Economic Association, vol. 14(1), pages 63-103, March.
    3. Herrera-Almanza, Catalina & Marquez-Padilla, Fernanda & Prina, Silvia, 2023. "C-Sections, Obesity, and Health-Care Specialization: Evidence from Mexico," IZA Discussion Papers 16302, Institute of Labor Economics (IZA).
    4. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    5. Victor Hugo de Oliveira & Ines Lee & Climent Quintana‐Domeque, 2022. "The effect of increasing Women's autonomy on primary and repeated caesarean sections in Brazil," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1800-1804, August.

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    More about this item

    Keywords

    health care; provider incentives; labor and delivery;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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