Abstract
Using data about births from the perinatal information system (PIS) registered in Montevideo (Uruguay), we estimated the probability of having a Caesarian section delivery, controlled by risk factors and the endogeneity of the choice of hospital. In public hospitals in Montevideo there is a fixed payment system, but in private hospitals this procedure has to be paid for separately. In the former, there is no effect on the doctor’s income if he performs a Caesarian, but in the latter there is a positive effect. Empirical evidence shows the probability of a Caesarean section increases with the age of the woman, the presence of eclampsy, pre-eclampsy, previous hypertension, previous Caesarean sections, multiple pregnancies and fetopelvic disproportion, and decreases for multiparous women and women in a public hospital. In fact, the probability of having a Caesarean section in a private institution is almost two times higher than in a public hospital (20% as against 39%). Focusing on women without risk factors, we found that the probability a Caesarian in a public hospital was 11%, but the probability in a private hospital was 25%. We conclude that the remuneration system explains an important part of this difference.
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This work was made possible due to the data provided by the Population Information Program of the Ministry of Public Health. Especially, we thank it director Dr. Teresa Puppo and Marinés Figueroa and Federico Ramos. We also thank the invaluable comments and suggestions on medical risks of Caesarian sections, from Dr. Rafael Aguirre. Any remaining errors are our own and the usual disclaimer applies.
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Triunfo, P., Rossi, M. The effect of physicians’ remuneration system on the Caesarean section rate: the Uruguayan case. Int J Health Care Finance Econ 9, 333–345 (2009). https://doi.org/10.1007/s10754-008-9054-y
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DOI: https://doi.org/10.1007/s10754-008-9054-y