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

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    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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    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
    Date of revision:
    Publication status: Published in
    Handle: RePEc:nav:ecupna:1212
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    Phone: 34 948 169340
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    Web page: http://www.econ.unavarra.es

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    1. Jeremiah Hurley & Roberta Labelle, 1995. "Relative fees and the utilization of physicians' services in Canada," Health Economics, John Wiley & Sons, Ltd., vol. 4(6), pages 419-438, November.
    2. Ma, Ching-to Albert, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 93-112, Spring.
    3. 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.
    4. 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.
    5. Epstein, Andrew J. & Nicholson, Sean, 2009. "The formation and evolution of physician treatment styles: An application to cesarean sections," Journal of Health Economics, Elsevier, vol. 28(6), pages 1126-1140, December.
    6. 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.
    7. 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.
    8. D. Fabbri & C. Monfardini, 2006. "Style of practice and assortative mating: a recursive probit analysis of cesarean section scheduling in Italy," Working Papers 557, Dipartimento Scienze Economiche, Universita' di Bologna.
    9. 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.
    10. 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.
    11. 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.
    12. 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 (Working Papers) 9335, Inter-American Development Bank.
    13. 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.
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