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Could Money Persuade Doctors to Perform more C-sections? Study Suggests Yes

Update Date: Aug 30, 2013 12:10 PM EDT

If there are no pregnancy complications, giving birth naturally via the vaginal canal or scheduling a birth via a Caesarean section are two good available options. For some pregnant women with busy schedules, making an appointment for when they want to give birth can be highly desirable. For other women, the painful route might be more appealing due to the fact that it is more natural. Regardless of which method pregnant women choose, a new study found that C-sections are more expensive. Based from this fact, the researchers were interested to see if the extra costs have influenced doctors in promoting C-sections as opposed to natural births. The study found that financial incentives appear to influence obstetricians' decisions to perform C-sections.

The researchers were interested in studying the relationship between financial incentives and medical decisions since the rate of C-sections has increased. In 1996, only around one in five infants were delivered via a C-section. Now, one in three babies is born due to this surgical procedure. From 1996 to today, the annual medical costs that come from births within the U.S. have increased by three billion.

In this study, health care economists Erin Johnson and M. Marit Rehavi calculated the costs of C-sections in comparison to natural births. They found that obstetricians who performed C-sections earned a few hundred dollars more for this procedure compared to a natural delivery. The hospitals that perform more C-sections could earn up to thousands of dollars more. The researcher theorized that doctors who are performing with financial incentives might be more inclined to persuade their non-doctor patients to get C-sections.

"The idea is that physicians have medical knowledge," Johnson explained according to NPR. "If the obstetrician is deviating from the best treatment because of their own financial incentive, the patient [who is a doctor] would be able to push back against the obstetrician. But that might not be the case for non-doctors because they simply do not have the medical knowledge to know whether or not this C-section is the appropriate [method of delivery] for them."

In order to test their hypothesis, the researchers looked at the number of births in California and Texas by using databases. They focused on when the patients were doctors to see if they chose C-sections when they did not need to. The researchers discovered that when doctors were patients, they were 10 percent less likely to get C-sections. The researchers believed that obstetricians treated doctor-patients differently than they did with patients that did not have a medical background.

Even though the researchers believe that obstetricians acted differently, they are not sure whether or not the difference is intended. The researchers believe that obstetricians could be influenced by monetary gains without realizing it. The team also looked at the frequency of the procedures done in hospitals where doctors received a flat salary. In these situations, the trend continued. More mothers who were not doctors received C-sections.  The researchers believe that by providing more education to pregnant women, they can make better decisions about how they want to give birth.

The paper was published by the National Bureau of Economic Research.

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