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Accounting for the Rise in C-sections: Evidence from Population Level Data


  • Sara Allin
  • Michael Baker
  • Maripier Isabelle
  • Mark Stabile


Drawing on administrative records of nearly 4 million births in Canada as well as macro data from the US and Australia, we provide a comprehensive account of rising C-section rates. We explicitly consider the contributions of the changing characteristics of mothers, births, and physicians as well as changing financial incentives for C-section deliveries. These factors account for at most one-half of the increase in C-section rates. The majority of the remaining increase in C-sections over the period 1994-2011 occurred in the early 2000s. We overview the relative contributions that the Hannah Breech Trial and technological change may have played in this development.

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  • 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.
  • Handle: RePEc:nbr:nberwo:21022
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    References listed on IDEAS

    1. Lee Jin Young & Solon Gary, 2011. "The Fragility of Estimated Effects of Unilateral Divorce Laws on Divorce Rates," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(1), pages 1-11, August.
    2. Jeffrey Clemens & Joshua D. Gottlieb, 2014. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?," American Economic Review, American Economic Association, vol. 104(4), pages 1320-1349, April.
    3. Neumark, David & Salas, J.M. Ian & Wascher, William, 2013. "Revisiting the Minimum Wage-Employment Debate: Throwing Out the Baby with the Bathwater?," IZA Discussion Papers 7166, Institute of Labor Economics (IZA).
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    6. Lefevre, M., 2014. "Physician induced demand for C-sections: does the convenience incentive matter?," Health, Econometrics and Data Group (HEDG) Working Papers 14/08, HEDG, c/o Department of Economics, University of York.
    7. Diane Alexander, 2013. "Does Physician Compensation Impact Procedure Choice and Patient Health?," Working Papers 1475, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
    8. Jasmin Kantarevic & Boris Kralj & Darrel Weinkauf, 2008. "Income effects and physician labour supply: evidence from the threshold system in Ontario," Canadian Journal of Economics, Canadian Economics Association, vol. 41(4), pages 1262-1284, November.
    9. Barer, M.L. & Lomas, J. & Sanmartin, C., 1996. "Re-Minding Our Ps and Qs : Medical Cost Controls in Canada," Centre for Health Services and Policy Research 96:6r, University of British Columbia - Centre for Health Services and Policy Research..
    10. Janet Currie & W. Bentley MacLeod, 2008. "First Do No Harm? Tort Reform and Birth Outcomes," The Quarterly Journal of Economics, Oxford University Press, vol. 123(2), pages 795-830.
    11. Shearer, Elizabeth L., 1993. "Cesarean section: Medical benefits and costs," Social Science & Medicine, Elsevier, vol. 37(10), pages 1223-1231, November.
    12. Justin Wolfers, 2006. "Did Unilateral Divorce Laws Raise Divorce Rates? A Reconciliation and New Results," American Economic Review, American Economic Association, vol. 96(5), pages 1802-1820, December.
    13. 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.
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    15. Grant, Darren, 2009. "Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project," Journal of Health Economics, Elsevier, vol. 28(1), pages 244-250, January.
    16. Vibeke Myrup Jensen, 2014. "Happy Doctor Makes Happy Baby? Incentivizing Physicians Improves Quality of Prenatal Care," The Review of Economics and Statistics, MIT Press, vol. 96(5), pages 838-848, December.
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    Cited by:

    1. de Elejalde, Ramiro & Giolito, Eugenio, 2019. "More Hospital Choices, More C-Sections: Evidence from Chile," IZA Discussion Papers 12297, Institute of Labor Economics (IZA).
    2. Berta, P.; & Martini, G.; & Piacenza, M.; & Turati, G.;, 2019. "The strange case of appropriate C-sections:DRG-tariff regulation, hospital ownership, and market concentration," Health, Econometrics and Data Group (HEDG) Working Papers 19/02, HEDG, c/o Department of Economics, University of York.
    3. Aleksandr Proshin & Alexandre Cazenave-Lacroutz & Zeynep Or & Lise Rochaix, 2018. "Impact of Diagnosis Related Group Refinement on the Choice Between Scheduled Caesarean Section and Normal Delivery: Recent Evidence from France," Working Papers halshs-01812107, HAL.

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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