Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-24T17:45:17.109Z Has data issue: false hasContentIssue false
  • English
  • Français

Econometric Analysis of Variation in Cesarean Section Rates: A Cross-sectional Study of 59 Obstetrical Departments in Sweden

Published online by Cambridge University Press:  10 March 2009

Ingemar Eckerlund  and
Ulf-G Gerdtham
Ingemar Eckerlund
Affiliation:
Stockholm School of Economics and The National Board of Health and Welfare
Ulf-G Gerdtham
Affiliation:
Stockholm School of Economics
Get access Rights & Permissions [Opens in a new window]

Abstract

The objective of this study was to explain the variation in cesarean section rates among hospitals (obstetrical departments) in Sweden, and to discuss its potential economic consequences. Using data from The Swedish Medical Birth Registry 1991, we made a cross-sectional study of the cesarean section rate at the departmental level. We identified some 20 determinants, demand-related as well as supply-related. A general model including all these regressors was specified. After reducing this model, we were able to explain about one-quarter of the variation. We conclude that the large variation in cesarean section rates indicates inefficiency, due mainly to overutilization, but perhaps also underutilization. It is difficult to calculate the economic consequences or the welfare loss to society. We estimated an additional cost for unnecessary cesarean sections of 13—16 million Swedish crowns (SEK) per year.

Keywords

Cesarean SectionPractice PatternsEconomicsRegression Analysis
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 14 , Issue 4 , Fall 1998 , pp. 774 - 787
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Adashek, J. A., Peaceman, A. M., & Lopec-Zeno, J. A., Factors contributing to the increased cesarean birth rate in older parturient women. American Journal of Obstetrics and Gynecology, 1993, 169, 936–40.CrossRefGoogle Scholar
2.Anderson, G. M., & Lomas, J.Determinants of the increasing cesarean birth rate. New England Journal of Medicine, 1984, 311, 887–92.CrossRefGoogle ScholarPubMed
3.Blomqvist, Å.The doctor as double agent: Information asymmetry, health insurance, and medical care. Journal of Health Economics, 1991, 10, 411–22.CrossRefGoogle ScholarPubMed
4.Breusch, T., & Pagan, A.A simple test for heteroskedasticity and random coefficient Variation. Econometrica, 1979, 47, 1287–94.CrossRefGoogle Scholar
5.Broadhead, T. J., & James, D. K. Worldwide utilization of cesarean section. In Flamm, B. L. & Quilligan, E. J. (eds.), Cesarean section: Guidelines for appropiate utilization. New York: Springer-Verlag, 1995, 9–21.CrossRefGoogle Scholar
6.Brown, H. S.Physician demand for leisure: Implications for cesarean section rates. Journal of Health Economics, 1996, 15, 233–42.CrossRefGoogle ScholarPubMed
7.Clark, L., Mugford, M., & Paterson, C.How does the mode of delivery affect the cost of maternity care? British Journal of Obstetrics and Gynaecology, 1991, 98, 519–23.CrossRefGoogle ScholarPubMed
8.Eckerlund, I., & Nielsen, T. F.Quality of care at delivery units: A survey study of obstetrical departments in Sweden. Unpublished memo, 1995.Google Scholar
9.Eisenberg, J.Doctors’ decisions and the cost of medical care: The reasons for doctors’ practice patterns and ways to change them. Ann Arbor, MI: Health Administration Press Perspectives, 1986.Google Scholar
10.Ellis, R. P., & McGuire, T. G.Provider behaviour under prospective reimbursement. Journal of Health Economics, 1986, 5, 129–51.CrossRefGoogle ScholarPubMed
11.Evans, R. G. The dog in the night: Medical practice variations and health policy. In Andersen, T. F. & Mooney, G. (eds.), The challenges of medical practice variations. London: Macmillan, 1990.Google Scholar
12.Finkler, M. D., & Wirtschafter, D. D.Cost-effectiveness and obstetric services. Medical Care, 1991, 29, 951–63.CrossRefGoogle ScholarPubMed
13.Flamm, B. L., & Quilligan, E. J. (eds). Cesarean section: Guidelines for appropriate utilization. New York: Springer-Verlag, 1995.CrossRefGoogle Scholar
14.Folland, S., & Stano, M.Sources of small area variations in the use of medical care. Journal of Health Economics 1989, 8, 85–107.CrossRefGoogle ScholarPubMed
15.Gardner, L. B. Economic considerations in cesarean section use. In: Flamm, B. L. & Quilligan, E. J. (eds.), Cesarean section: Guidelines for appropiate utilization. New York: Springer-Verlag, 1995, 173–190.CrossRefGoogle Scholar
16.Gerdtham, U.-G.Essays on international comparisons of health care expenditure. Ph.D dissertation. Linkoping: Universitetet i Linköping, 1991 (Linköping Studies in Art and Science, No. 66).Google Scholar
17.Goyert, G. L., Bottoms, S. F., Treadwell, M. C., & Nehra, P. C.The physician factor in cesarean birth rates. New England Journal of Medicine, 1989, 320, 706–09.CrossRefGoogle ScholarPubMed
18.Gujarati, D. N.Basic econometrics, 2nd ed.New York: McGraw-Hill, 1988.Google Scholar
19.Jarque, C. M., & Bera, A. K.A test for normality of observations and regression residuals. International Statistical Review, 1987, 55, 163–72.CrossRefGoogle Scholar
20.Keeler, E. B., & Brodie, M.Economic incentives in the choice between vaginal delivery and cesarean section. The Milbank Quarterly, 1993, 71, 365–04.CrossRefGoogle ScholarPubMed
21.Kmenta, J.Elements of econometrics. 2nd ed.New York: Macmillan, 1986.Google Scholar
22.Lomas, J., & Enkin, M. Variations in operative delivery. In Chalmers, I., Enkin, M., & Keirse, M. (eds.) Effective care in pregnancy and childbirth, vol. 2. Oxford: Oxford University Press, 1991.Google Scholar
23.Manning, W. G., Newhouse, J. P., Dvan, N., et al. Health insurance and the demand for medical care: Evidence from a randomized experiment. American Economic Review, 1987, 77, 251.Google ScholarPubMed
24.McCloskey, L., Petitti, D. B., & Hobel, C. J.Variations in the use of cesarean delivery for dystocia: Lessons about the source of care. Medical Care, 1992, 30, 126–35.CrossRefGoogle ScholarPubMed
25.Nielsen, T. F.Kejsarsnitt i modern obstetrik: Vad är vetenskap och beprovad erfarenhet? Läkartidningen 1985, 82,1441–43.Google Scholar
26.Nielsen, T. F., Otterblad Olausson, P., & Ingemarsson, I.The cesarean section rate in Sweden: The end of the rise. Birth, 1994, 21, 1.CrossRefGoogle ScholarPubMed
27.Notzon, F. C., Placek, P. J., & Taffel, S. M.Comparison of national cesarean-section rates. New England Journal of Medicine, 1987, 316, 386–89.CrossRefGoogle ScholarPubMed
28.Notzon, F.C., Cnattingius, S., Bergsjö, P., et al. Cesarean section delivery in the 1980’s: International comparison by indication. American Journal of Obstetrics and Gynecology 1994, 170, 495–504.CrossRefGoogle Scholar
29.Phelps, C. E.Diffusion of information in medical care. Journal of Economic Perspectives, 1992, 6, 23–42.CrossRefGoogle ScholarPubMed
30.Phelps, C. E., & Mooney, C.Correction and update on ‘Priority Setting in Medical Technology Assessment. Medical Care, 1992, 30, 744–51.CrossRefGoogle ScholarPubMed
31.Phelps, C. E., & Mooney, C. Variations in medical practice use: Causes and consequences. In Arnould, R. J., Rich, R. F., White, W. D. (eds.), Competitive approaches to health care reform. Washington DC: Urban Institute Press, 1993.Google Scholar
32.Phelps, C. E., & Parente, S. T.Priority setting in medical technology and medical practice assessment. Medical Care, 1990, 28, 703–23.CrossRefGoogle ScholarPubMed
33.Rates of cesarean delivery—United States, 1991. MMWR, 1993, 42, 285–89.Google Scholar
34.Ryan, M., & Mooney, G.Research in medical practice variations: Where now? A paper for debate. Aberdeen. HERU, University of Aberdeen. Discussion paper 06/91.Google Scholar
35.Stafford, R. S.Cesarean section use and source of payment: An analysis of California hospital discharge abstracts. American Journal of Public Health, 1990, 80, 313–15.CrossRefGoogle ScholarPubMed
36.Stafford, R. S.The impact of nonclinical factors on repeat cesarean section. JAMA, 1991, 265, 59–63.CrossRefGoogle ScholarPubMed
37.Stephensen, P. A.International differences in the use of obstetrical interventions. Copenhagen: WHO Regional Office for Europe, 1991 (EUR/ICP/MCH 112).Google Scholar
38.Tussing, A. D., & Wojtowycz, M. A.The cesarean decision in New York State, 1986: Economic and noneconomic aspects. Medical Care, 1992, 30, 529–40.CrossRefGoogle ScholarPubMed
39.Tussing, A. D., & Wojtowycz, M. A.The effect of physician characteristics on clinical behavior: Cesarean section in New York state. Social Science and Medicine, 1993, 37, 1251–60.CrossRefGoogle ScholarPubMed
40.Wennberg, J. E.Dealing with medical practice variations: A proposal for action. Health Affairs, 1984, 3, 6–32.CrossRefGoogle ScholarPubMed
41.Wennberg, J. E., Barnes, B.A., & Zubkoff, M.Professional uncertainty and the problem of supplier-induced demand. Social Science and Medicine, 1982, 16, 811–24.CrossRefGoogle ScholarPubMed
42.Westert, G. P., Nieboer, A. P., & Groenewegen, P. P.Variation in duration of hospital stay between hospitals and between doctors within hospitals. Social Science and Medicine, 1993, 37, 833–39.CrossRefGoogle ScholarPubMed
43.Zahniser, S. C., Kendrick, J. S., Franks, A. L., et al. Trends in obstetric operative procedures, 1980 to 1987. American Journal of Public Health, 1992, 82, 1340–44.CrossRefGoogle ScholarPubMed