Over-utilization of cesarean sections and misclassification error

  • Alejandro ArrietaEmail author


This paper develops a model for defining Cesarean sections’ over- and under-utilization as deviations from clinically appropriate treatment due to non-clinical factors. Physician decisions can be affected by both monetary and non-monetary incentives, and the perception of the patient’s medical information and preferences. This structural model elucidates the physician decision-making process and identifies and tests for the degree of deviation from appropriate treatment (over- and under-utilization). The model is applied to estimate over-utilization of Cesarean section deliveries performed in the state of New Jersey during the 1999–2002 period. Non-clinically appropriate Cesarean sections occur at a moderate but growing rate of roughly 3.2 %. The growth of the Cesarean section rate in New Jersey over these years was explained mainly by non-clinical factors.


Healthcare utilization Misclassification model Cesarean section Physician incentives 


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Health Policy and ManagementFlorida International UniversityMiamiUSA

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