There have been several studies which have looked into the economic incentives which might play into the decision making that leads to a cesarean birth, but a new report for the National Bureau of Economic Research (recently reported on NPR) has found that cesareans are 10% less likely when the patient in labor is a physician. In other words, the more informed the patient is, the lower the chances of a cesarean.
In some ways, this is analogous to what happens when people take their cars to mechanics. People who are knowledgeable about cars are likely to push back against unnecessary repairs, whereas those who don’t know much about cars are less likely to take issue with the mechanic’s advice.
And interestingly enough, the converse is true when there are no financial incentives at play, i.e. when obstetricians receive a flat fee whether they perform surgery or not, in which case physician patients are more likely to receive cesareans…which kind of makes you wonder about the other patients who probably should be receiving cesareans, but aren’t.
Here’s the full abstract:
Physicians Treating Physicians: Information and Incentives in Childbirth
Erin M. Johnson and M. Marit Rehavi
NBER Working Paper No. 19242
JEL No. I10
This paper provides new evidence on the interaction between patient information and financial incentives
in physician induced demand (PID). Using rich microdata on childbirth, we compare the treatment
of physicians when they are patients with that of comparable non-physicians. We exploit a unique
institutional feature of California to determine how inducement varies with obstetricians’ financial
incentives. Consistent with PID, physicians are almost 10 percent less likely to receive a C-section,
with only a quarter of this effect attributable to differential sorting of patients to hospitals or obstetricians.
Financial incentives have a large effect on C-section probabilities for non-physicians, but physician-
patients are relatively unaffected. Physicians also have better health outcomes, suggesting overuse of
C-sections adversely impacts patient health