Physician Financial Incentives and Cesarean Section Delivery
The 'induced demand' model states that in the face of negative income shocks physicians may exploit their agency relationship with patients by providing excessive care in order to maintain their incomes. We test this model by exploiting an exogenous change in the financial environment facing obstetrician/gynecologists during the 1970s: declining fertility in the U.S. We argue that the 13.5% fall in fertility over the 1970-1982 period increased the income pressure on ob/gyns, and led them to substitute from normal childbirth towards a more highly reimbursed alternative, cesarean delivery. Using a nationally representative micro-data set for this period, we show that there is a strong correlation between within state declines in fertility and within state increases in cesarean utilization. This correlation is robust to consideration of a variety of alternative hypotheses, and appears to be symmetric with respect to periods of fertility decline and fertility increase.
|Date of creation:||Nov 1994|
|Date of revision:|
|Publication status:||published as Rand Journal of Economics, Spring 1996|
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- J Hurley & R Labelle & T Rice, 1990. "The Relationship Between Physician Fees and the Utilization of Medical Services in Ontario," Centre for Health Economics and Policy Analysis Working Paper Series 1990-04, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
- Grytten, Jostein & Holst, Dorthe & Laake, Peter, 1990. "Supplier inducement : Its effect on dental services in Norway," Journal of Health Economics, Elsevier, vol. 9(4), pages 483-491, December.
- Gruber, J., 1992.
"The Efficiency of a Group-Specific Mandated Benefit: Evidence from Health Insurance Benefits for Maternity,"
92-19, Massachusetts Institute of Technology (MIT), Department of Economics.
- Jonathan Gruber, 1992. "The Efficiency of a Group-Specific Mandated Benefit: Evidence From Health Insurance Benefits for Maternity," NBER Working Papers 4157, National Bureau of Economic Research, Inc.
- Thomas G. McGuire & Mark V. Pauly, 1991. "Physician Response to Fee Changes with Multiple Payers," Papers 0015, Boston University - Industry Studies Programme.
- Goddeeris, John H, 1984. "Medical Insurance, Technological Change, and Welfare," Economic Inquiry, Western Economic Association International, vol. 22(1), pages 56-67, January.
- McGuire, Thomas G. & Pauly, Mark V., 1991. "Physician response to fee changes with multiple payers," Journal of Health Economics, Elsevier, vol. 10(4), pages 385-410.
- T Rice & R Labelle, 1989. "Do Physicians Induce Demand for Medical Service?," Centre for Health Economics and Policy Analysis Working Paper Series 18, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
- David Bloom & James Trussell, 1984. "What are the determinants of delayed childbearing and permanent childlessness in the United States?," Demography, Springer, vol. 21(4), pages 591-611, November.
- Cromwell, Jerry & Mitchell, Janet B., 1986. "Physician-induced demand for surgery," Journal of Health Economics, Elsevier, vol. 5(4), pages 293-313, December.
- Victor R. Fuchs, 1978. "The Supply of Surgeons and the Demand for Operations," NBER Working Papers 0236, National Bureau of Economic Research, Inc.
- David E. Bloom & James Trussell, 1983. "What Are the Determinants of Delayed Childbearing and Permanent Childlessness in the United States?," NBER Working Papers 1140, National Bureau of Economic Research, Inc.
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