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Delivering Privately: Cesarean Practice and Long-Term Maternal Health

Author

Listed:
  • de Elejalde, Ramiro

    (Banco Central de Chile)

  • Giolito, Eugenio

    (Universidad del CEMA)

Abstract

We study the causal effect of delivering in a private rather than a public hospital on maternal outcomes in Chile. We exploit a 2003 copayment reduction that expanded access to private hospitals for women insured by the public system as an instrument for private delivery. Combining administrative birth records with hospital discharge data, we estimate an instrumented difference-in-differences model that follows mothers for up to fifteen years after the first birth. Private hospital delivery improves short-term outcomes, reducing prolonged hospitalizations and 30-day readmissions. The offsetting risks come with later pregnancies: women induced to deliver in private hospitals face higher rates of repeat C-sections, cesarean-scar complications, and hysterectomy. Subsequent fertility is unaffected. The results point to a trade-off between short-run improvements and long-run maternal health risks from hospital practices that favor planned cesarean delivery.

Suggested Citation

  • de Elejalde, Ramiro & Giolito, Eugenio, 2026. "Delivering Privately: Cesarean Practice and Long-Term Maternal Health," IZA Discussion Papers 18877, IZA Network @ LISER.
    • Handle: RePEc:iza:izadps:dp18877
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    References listed on IDEAS

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    1. David Card & Alessandra Fenizia & David Silver, 2023. "The Health Impacts of Hospital Delivery Practices," American Economic Journal: Economic Policy, American Economic Association, vol. 15(2), pages 42-81, May.
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    Keywords

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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth

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