Bachner, Florian; Halla, Martin (2022): Do Empty Beds Cause Caesarean Deliveries? European Health Economics Association (EuHEA) conference, 9. Juli 2022, Oslo.

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Abstract

While there is a common understanding that Caesarean sections (C-sections) can be a lifesaving and necessary procedure, it is also evident that C-sections may result in increased maternal mortality, maternal and infant morbidity, and increased complications for subsequent deliveries. Many highly industrialised countries have faced sharp increases in rates of Caesarean sections over the past decades. In 1985 the World Health Organization recommended an ideal rate of C-sections between 10-15% and concluded that rates higher than 10% are not associated with reductions in maternal and newborn mortality rates at the population level. In 2017 about 28% of all live births were performed as caesarean sections in OECD countries. Literature attributes the increase in C-sections rates and the large variations between countries to various factors such as malpractice liability concerns, different quality or different skills and training of medical staff, mothers preferences towards labour and birth or psychological factors such as fear. However, little is known about health economic reasons and incentives such as remuneration or impact of ward utilization rates. Modern health-care systems should be able to provide a comprehensive range of services and ensure certain standards of quality at any given point in time. Therefore, responsible capacity planning has to account for certain peaks in patient loads. Systems have to be able to cope with predictable peaks, such as the flu season, but also withstand nonpredictable events such as the COVID-19 pandemic. As a consequence, during normal periods a certain level of medical resources are free. This raises the important question whether (and to what extent) the supply of these resources affects health-care utilization beyond an efficient level. Our study investigates the impact of free capacities on health-care utilization during regular periods. We examine this question in the context of maternity wards and test to which extent idiosyncratic variation in the number of available beds has an impact on the incidence of C-sections. Our empirical analysis is based on high quality administrative data from Austria covering all inpatient births in the period between 2002 and 2018. We find substantial variation over weekdays, hospitals and between public and private hospitals. Average occupancy rate is 75 percent on maternity wards, thereof 75% are occupied by expecting mothers. Our results show that a one standard deviation increase in the share of beds occupied by births decreases the likelihood of a C-sections by 1.14 percentage points or 4.21 percent. The result remains robust after including covariates for patients non giving birth and staffing levels.

Item Type: Conference or Workshop Item (Paper)
Subjects: OEBIG > Gesundheitsoekonomie und –systemanalyse
Date Deposited: 03 Apr 2023 05:37
Last Modified: 03 Apr 2023 05:37
URI: https://jasmin.goeg.at/id/eprint/2428