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More Hospital Choices, More C-Sections: Evidence from Chile

Author

Listed:
  • de Elejalde, Ramiro

    (Universidad Alberto Hurtado)

  • Giolito, Eugenio

    (Universidad del CEMA)

Abstract
In this paper, we study the effect on cesarean rates of a policy change in Chile that decreased the cost of delivery at private hospitals for women with public health insurance. Using a difference-in-differences (DID) approach based on the eligibility conditions for this benefit, we find that in the first three years after the policy took effect, deliveries in private hospitals increased by 8.7 percentage points, while the probability of a C-section being performed increased by 4.6 percentage points, with negative impacts on average newborn weight and size at birth. We show that the probability of an early term birth in hospitals participating in the program is an increasing function of expected hospital demand at the time of the full-term due date. This suggests that in the absence of price incentives, hospitals use C-sections to smooth out demand over time to optimize the use of their resources.

Suggested Citation

  • de Elejalde, Ramiro & Giolito, Eugenio, 2019. "More Hospital Choices, More C-Sections: Evidence from Chile," IZA Discussion Papers 12297, Institute of Labor Economics (IZA).
  • Handle: RePEc:iza:izadps:dp12297
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    References listed on IDEAS

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    6. Costa-Ramón, Ana María & Rodríguez-González, Ana & Serra-Burriel, Miquel & Campillo-Artero, Carlos, 2018. "It's about time: Cesarean sections and neonatal health," Journal of Health Economics, Elsevier, vol. 59(C), pages 46-59.
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    10. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    11. 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.
    12. Janet Currie & W. Bentley MacLeod, 2008. "First Do No Harm? Tort Reform and Birth Outcomes," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 123(2), pages 795-830.
    13. Lien, Hsien-Ming & Chou, Shin-Yi & Liu, Jin-Tan, 2008. "Hospital ownership and performance: Evidence from stroke and cardiac treatment in Taiwan," Journal of Health Economics, Elsevier, vol. 27(5), pages 1208-1223, September.
    14. Michael Frakes & Jonathan Gruber, 2020. "Defensive Medicine and Obstetric Practices: Evidence from the Military Health System," Journal of Empirical Legal Studies, John Wiley & Sons, vol. 17(1), pages 4-37, March.
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    Cited by:

    1. Catalina Herrera-Almanza & Fernanda Marquez-Padilla & Silvia Prina, 2024. "C-Sections, Obesity, and Healthcare Specialization: Evidence from Mexico," The World Bank Economic Review, World Bank, vol. 38(1), pages 139-160.
    2. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    3. Julio Cáceres-Delpiano & Eugenio Giolito, 2023. "Minimum age requirements and the role of the school choice set," SERIEs: Journal of the Spanish Economic Association, Springer;Spanish Economic Association, vol. 14(1), pages 63-103, March.
    4. Victor Hugo de Oliveira & Ines Lee & Climent Quintana‐Domeque, 2022. "The effect of increasing Women's autonomy on primary and repeated caesarean sections in Brazil," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1800-1804, August.
    5. Facchini, Gabriel, 2022. "Low staffing in the maternity ward: Keep calm and call the surgeon," Journal of Economic Behavior & Organization, Elsevier, vol. 197(C), pages 370-394.

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    More about this item

    Keywords

    health care; provider incentives; labor and delivery;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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