In the United States about a third of babies born today are delivered via cesarean section. This is compared to the one in five babies delivered via the same surgical procedure in 1996. In this same period of time, the yearly medical cost of childbirth in the United States has increased by $3 billion annually. Additionally, the rate of cesarean section deliveries varies significantly in different parts of the country. A new study that looks at the links between economic incentives and medical decision-making during the delivery of a child has found that when there are financial incentives, obstetricians perform more cesarean sections.
In many medical settings, obstetricians are paid more for cesarean sections. Two health care economists calculated that doctors could make up to a few hundred dollars more if they perform a cesarean section compared to a vaginal delivery. In addition, the hospital may make a few thousand dollars more if a cesarean section is performed.
The economists decided to explore the issue in an unusual way. They hypothesized if patients had significant medical expertise and knowledge that an obstetrician would be less likely to be swayed by the financial incentives to perform a cesarean section. Conversely, if the patient knew very little, financial incentives may play a larger role in the doctor’s medical decision making. This line of thinking would indicate that obstetricians would perform fewer cesarean sections if the patient was a doctor themselves.
In collecting data for this study, the researchers tracked births in California via databases and checked to see whether the mothers were doctors. The data showed that doctors are about 10 percent less likely to undergo a cesarean section for delivery of their baby. Therefore, it would appear that obstetricians would appear to be treating their physician patients differently from their non-physician patients.
The economists do not believe that these incentives play a conscious role in the doctor’s decision. When cesarean sections were scheduled in advance, there was no disparity in the cesarean section rate of physician and non-physician mothers. The disparity occurred when there were unscheduled cesarean sections, when labor has been attempted but does not go well. At this point a decision must be made whether or not to terminate the labor and deliver the baby surgically.
Additionally, there appeared to also be a disparity between whether a cesarean section is performed based on whether the doctor receives a flat salary. A flat salary seems to give a disincentive to perform the surgical procedures since they often involve more time. In this case it appeared that mothers who were physicians received more cesarean sections whereas mothers who were not physicians had a lower rate, indicating that some non-physician mothers who needed cesarean sections may not be getting them.
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