Although the overprovision of C-sections and other medical procedures has been commonly associated with private hospitals, in Non-elective C-sections in public hospitals: capacity constraints and doctor incentives, Florida International University Robert Stempel College of Public Health & Social Work professor Alejandro Arrieta shows that demand increases may augment the rate of utilization of unplanned or non-elective caesarean section in the public sector due to the physician’s leisure preferences. This finding applies to the smaller hospitals in the sample and is stronger for afternoon shifts.
Using administrative records of births from the Perinatal Surveillance System of the Peruvian Social Security System (ESSALUD), Dr. Arrieta and Ariadna García Prado of Universidad Pública de Navarra in Spain tested whether high admissions of pregnant women affected non-elective C-section rates in the ESSALUD public hospitals during 2005-2006. They present a basic theoretical model that considers physician preferences for leisure as well as hospital capacity constraints, and tested the model predictions. Their findings show that physician demand for leisure increases the probability of C-sections in small and medium-size hospitals, while hospital capacity constraints set a limit on them.
Other research on healthcare utilization in public and private facilities has found that the payment structure in the private sector leads to over-utilization of C-sections and other procedures. However, Arrieta and García Prado show that incentives for leisure time are also important and may increase C-sections, as was found in the smaller hospitals of the sample. This effect is somehow counterbalanced by public hospitals’ capacity constraints, which are not as prevalent in the private sector.
“These findings are relevant not only for Peru or Latin America, where the numbers of C-sections are especially high, but also to other countries with similarly high rates,” said Arrieta.