Physician Incentives and the Timing of Cesarean Sections

Evidence From California

Dados Bibliográficos

ID9103687
AutoresJoanne Spetz (0000-0003-3112-5511, Public Policy Institute of California, autor correspondente), Mark W Smith (0000-0002-4582-9088), Sean F Ennis, Séan Ennis (0000-0001-6796-5788)
Ano2001
Volume39
Fascículo6
Páginas536-550
Data de publicação2001-06-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-200106000-00003
PMID11404639
OpenAlexW2006382986
IdiomaEN
Citações recebidas10
Referências citadas18

OBJECTIVES: The timing of cesarean sections is studied to examine how physician convenience and financial incentives play a role in the decision to perform a cesarean section. METHODS: Using birth certificate and hospital financial data from California, the likelihood of cesarean sections being performed at particular times of day was examined, controlling for maternal characteristics and the mother's insurance coverage. Two diagnoses associated with cesarean sections are examined separately: fetal distress and prolonged/dysfunctional labor. The hypotheses are that cesarean sections performed for physician convenience are more likely to occur in the evening hours and that type of insurance will affect the incentive to perform cesarean sections to obtain leisure. RESULTS: The probability of cesarean sections for patients insured by a group-model HMO is more stable during the course of a day than that for patients insured by all other insurance plans. Group-model HMO patients with previous cesarean sections are less likely to have cesarean sections in the evening hours and are less likely to be diagnosed with fetal distress or prolonged/dysfunctional labor. CONCLUSIONS: The differences in cesarean sections and diagnosis rates between group-model HMO patients and other patients could arise from several mechanisms: group-model HMOs provide consistent financial incentives to their staff, they may be better able to guide physician practice, and they might provide staff support to physicians so there is less leisure-based incentive to perform cesarean sections. In contrast, nongroup-model HMOs do not appear to reduce the incentive of physicians to maximize leisure relative to traditional insurance

Birth certificate · Dysfunctional family · Economics · Evening · Fetal distress · Fetus · Health care · Incentive · Medicaid · Obstetrics · Population · Pregnancy · Psychiatry · Healthcare Policy and Management · Hospital Admissions and Outcomes · Maternal and Perinatal Health Interventions · Medicine