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Cesarean sections: Use or abuse?




The cesarean rate in Italy is about 34%, higher than in other European countries and in the United States. It has been rising dramatically over the past decades and it varies considerably across geographical areas. I show that such geographical variation is not driven by medical need and that higher cesarean rates are achieved by performing the procedure on less and less appropriate patients. I find no evidence that high-use areas develop higher ability in performing cesareans. Finally, by using both panel data analysis and instrumental variables, I show that there is no significant relation between risk-adjusted cesarean rates and maternal and neonatal mortality. The combined evidence in this paper suggests that lowering cesarean rates would likely affect less appropriate patients, would not have negative spillovers in terms of quality of the procedure and would not affect neonatal nor maternal mortality. JEL Classification: I1, H42.

Suggested Citation

  • Annalisa Scognamiglio, 2019. "Cesarean sections: Use or abuse?," CSEF Working Papers 534, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
  • Handle: RePEc:sef:csefwp:534

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    References listed on IDEAS

    1. Amitabh Chandra & Douglas O. Staiger, 2007. "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks," Journal of Political Economy, University of Chicago Press, vol. 115(1), pages 103-140.
    2. Marina Cavalieri & Calogero Guccio & Domenico Lisi & Giacomo Pignataro, 2014. "Financial Incentives and Inappropriateness in Health Care: Evidence from Italian Cesarean Sections," FinanzArchiv: Public Finance Analysis, Mohr Siebeck, Tübingen, vol. 70(3), pages 430-457, September.
    3. Beomsoo Kim, 2007. "The Impact of Malpractice Risk on the Use of Obstetrics Procedures," The Journal of Legal Studies, University of Chicago Press, vol. 36(S2), pages 79-119, June.
    4. 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.
    5. Maura Francese & Massimiliano Piacenza & Marzia Romanelli & Gilberto Turati, 2011. "Understanding Inappropriateness in Health Care: The Role of Supply Structure, Pricing Policies and Political Institutions in Caesarean Deliveries," ERSA conference papers ersa11p1439, European Regional Science Association.
    6. 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.
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    More about this item


    Cesarean section; neonatal and maternal health.;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods

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