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An impact evaluation of the strategy for normal birth care on caesarean section rates and perinatal mortality in Spain

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  • Recio Alcaide, Adela
  • Arranz, José M.

Abstract

The objectives of this research are to evaluate the impact of a health policy (the Strategy for Normal Birth Care, EAPN) on caesarean rates and perinatal mortality in Spanish public hospitals belonging to the National Health System (NHS) and to assess the related cost savings. Data from the Spanish Ministry of Health for the period 2002−2011 and quantitative impact evaluation techniques (double difference method) are used to compare the effects of this policy in a treatment group composed of the NHS hospitals and a control group made up of private for-profit hospitals outside the scope of the EAPN. Both groups are compared some years before and after the health policy initiated in 2006 and approved in October 2007. The estimation results show that the EAPN had a significant effect in reducing caesarean rates of approximately 2 percentage points between 2007 and 2011, with increasing cost savings over the years ranging from 24 to 44 million euros depending on the year. Furthermore, EAPN reduced perinatal mortality levels by 0.08% in years 2008−2009.

Suggested Citation

  • Recio Alcaide, Adela & Arranz, José M., 2022. "An impact evaluation of the strategy for normal birth care on caesarean section rates and perinatal mortality in Spain," Health Policy, Elsevier, vol. 126(1), pages 24-34.
    • Handle: RePEc:eee:hepoli:v:126:y:2022:i:1:p:24-34
    DOI: 10.1016/j.healthpol.2021.11.003
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    References listed on IDEAS

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    1. Alberto Abadie, 2005. "Semiparametric Difference-in-Differences Estimators," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 72(1), pages 1-19.
    2. Jonathan Gruber & Maria Owings, 1996. "Physician Financial Incentives and Cesarean Section Delivery," RAND Journal of Economics, The RAND Corporation, vol. 27(1), pages 99-123, Spring.
    3. Litorp, Helena & Mgaya, Andrew & Mbekenga, Columba K. & Kidanto, Hussein L. & Johnsdotter, Sara & Essén, Birgitta, 2015. "Fear, blame and transparency: Obstetric caregivers' rationales for high caesarean section rates in a low-resource setting," Social Science & Medicine, Elsevier, vol. 143(C), pages 232-240.
    4. Graham Cookson & Ioannis Laliotis, 2018. "Promoting normal birth and reducing caesarean section rates: An evaluation of the Rapid Improvement Programme," Health Economics, John Wiley & Sons, Ltd., vol. 27(4), pages 675-689, April.
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    More about this item

    Keywords

    Health policy; Impact evaluation; Caesarean; Births; Perinatal mortality; Public and private hospitals; JEL Classification:; C21; I11; I14; I18; J16; L33;
    All these keywords.

    JEL classification:

    • C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J16 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Gender; Non-labor Discrimination
    • L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out

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