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Changing physicians’ incentives to control the C-section rate: Evidence from a major health care reform in Iran

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  • Pilvar, Hanifa
  • Yousefi, Kowsar

Abstract

We evaluate the effect of a major health care policy in public hospitals which changed the demand and supply side incentives for c-section procedures in 2014 in Iran, where the c-section rate at the time was 55%. Following the reform, vaginal delivery became free for patients. The policy also introduced financial incentives to doctors for performing vaginal deliveries and set a cap on their maximum c-section rate. We show that supply side incentives had a major role in the effectiveness of the programme, after which the national rate reduced by 6 percentage points. This reduction was mainly driven by first-birth mothers. The reform also shifted doctors with high c-section rates out of public hospitals. We cannot find any adverse effect on Apgar score, hospitalisation or mortality; however, gestation length and birth weight significantly increased.

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  • Pilvar, Hanifa & Yousefi, Kowsar, 2021. "Changing physicians’ incentives to control the C-section rate: Evidence from a major health care reform in Iran," Journal of Health Economics, Elsevier, vol. 79(C).
    • Handle: RePEc:eee:jhecon:v:79:y:2021:i:c:s0167629621000990
    DOI: 10.1016/j.jhealeco.2021.102514
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    References listed on IDEAS

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    Cited by:

    1. Carolina Melo & Naercio Menezes‐Filho, 2023. "The effects of a national policy to reduce c‐sections in Brazil," Health Economics, John Wiley & Sons, Ltd., vol. 32(2), pages 501-517, February.
    2. Bachner, Florian & Halla, Martin & Pruckner, Gerald J., 2024. "Do Empty Beds Cause Cesarean Deliveries?," IZA Discussion Papers 16981, Institute of Labor Economics (IZA).

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    More about this item

    Keywords

    C-section; Health policy; Physicians’ Financial incentives; Birth timing;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth

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