Easy Like Sunday Morning: Organizational Design and Physician Agency in Birth Timing

Cesarean rates differ sharply between private and public hospitals in Buenos Aires, even though payments do not vary with delivery mode in either sector. We argue this gap reflects organizational design rather than procedure prices. In the Buenos Aires metropolitan area, individualized private and team-based public maternity care coexist within the same labor market. Using ex ante preferences and medical records for low-risk first-time mothers, we document a preference margin and a timing margin. Stated preferences for cesarean predict scheduled procedures strongly in private hospitals and not at all in public ones. Elective cesareans in private hospitals cluster on boundary working days (the Monday or Friday adjacent to a weekend or holiday), and the intrapartum cesarean rate is about 13 percentage points higher on working than nonworking days in private hospitals, but indistinguishable from zero in public ones, a gradient that reflects selection induced by the timing margin. A simple model rationalizes both margins through the opportunity cost of physician time, internalized only when physicians are residual claimants of their own schedule. Organizational design, not procedure prices, is the primary lever behind the discretionary component of cesarean use.