IDEAS home Printed from https://ideas.repec.org/p/iim/iimawp/14595.html
   My bibliography  Save this paper

Too much care? Private health care sector and surgical interventions during childbirth in India

Author

Listed:
  • Surana, Mitul
  • Dongre, Ambrish

Abstract

This paper evaluates the role of the private sector in performing one of the common surgical interventions, i.e. caesarean sections during childbirth in India. We use the latest round of National Family Health Survey to estimate the differential probability of C-section in private medical facilities relative to government facilities. We employ two estimation techniques, Household Fixed Effects and Coarsened Exact Matching, to reduce the extent of selection bias in the choice of delivery location. We also take advantage of a new question introduced in the survey which allows identification of planned C-sections which are more likely to be the result of either demand for C-section or unobservable (in the data) medical risks. We find that the probability of an unplanned C-section is 13.5-14 percentage points higher in the private sector. Given that some of the planned C-sections could be a result of supplier-induced demand, this is a very conservative estimate. Our results suggest that there were potentially 0.9 million preventable C-sections in the private sector in 2016. These results therefore call for a critical assessment of the role of private sector in healthcare in the context of inadequate public provision, expanding private provision and weak governance structures.

Suggested Citation

  • Surana, Mitul & Dongre, Ambrish, 2018. "Too much care? Private health care sector and surgical interventions during childbirth in India," IIMA Working Papers WP 2018-11-01, Indian Institute of Management Ahmedabad, Research and Publication Department.
    • Handle: RePEc:iim:iimawp:14595
    as

    Download full text from publisher

    File URL: https://www.iima.ac.in/sites/default/files/rnpfiles/916097432018-11-01.pdf
    File Function: English Version
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Gans, Joshua S. & Leigh, Andrew & Varganova, Elena, 2007. "Minding the shop: The case of obstetrics conferences," Social Science & Medicine, Elsevier, vol. 65(7), pages 1458-1465, October.
    2. Besley, Timothy & Malcomson, James M., 2018. "Competition in public service provision: The role of not-for-profit providers," Journal of Public Economics, Elsevier, vol. 162(C), pages 158-172.
    3. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    4. Brown, H. III, 1996. "Physician demand for leisure: implications for cesarean section rates," Journal of Health Economics, Elsevier, vol. 15(2), pages 233-242, April.
    5. Alejandro Arrieta & Ariadna García Prado, 2016. "Non-elective C-sections in public hospitals: capacity constraints and doctor incentives," Applied Economics, Taylor & Francis Journals, vol. 48(49), pages 4719-4731, October.
    6. Chalkley, Martin & Listl, Stefan, 2018. "First do no harm – The impact of financial incentives on dental X-rays," Journal of Health Economics, Elsevier, vol. 58(C), pages 1-9.
    7. Abhijit Banerjee & Angus Deaton & Esther Duflo, 2004. "Wealth, Health, and Health Services in Rural Rajasthan," American Economic Review, American Economic Association, vol. 94(2), pages 326-330, May.
    8. Padmadas, Sabu S. & Kumar S., Suresh & Nair, Sajini B. & Kumari K.R., Anitha, 2000. "Caesarean section delivery in Kerala, India: evidence from a National Family Health Survey," Social Science & Medicine, Elsevier, vol. 51(4), pages 511-521, August.
    9. Papanicolas, Irene & McGuire, Alistair, 2015. "Do financial incentives trump clinical guidance? Hip Replacement in England and Scotland," Journal of Health Economics, Elsevier, vol. 44(C), pages 25-36.
    10. Lobel, Marci & DeLuca, Robyn Stein, 2007. "Psychosocial sequelae of cesarean delivery: Review and analysis of their causes and implications," Social Science & Medicine, Elsevier, vol. 64(11), pages 2272-2284, June.
    11. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
    12. Kaveri Gill, 2009. "A Primary Evaluation of Service Delivery under the National Rural Health Mission (NRHM): Findings from a Study in Andhra Pradesh, Uttar Pradesh, Bihar and Rajasthan," Working Papers id:2006, eSocialSciences.
    13. Planning Commission, 2011. "High Level Expert Group Report on Universal Health Coverage for India," Working Papers id:4646, eSocialSciences.
    14. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    15. Wang, Eileen, 2017. "Requests for cesarean deliveries: The politics of labor pain and pain relief in Shanghai, China," Social Science & Medicine, Elsevier, vol. 173(C), pages 1-8.
    16. David Card & Alessandra Fenizia & David Silver, 2018. "The Health Effects of Cesarean Delivery for Low-Risk First Births," NBER Working Papers 24493, National Bureau of Economic Research, Inc.
    17. Arrieta, Alejandro, 2011. "Health reform and cesarean sections in the private sector: The experience of Peru," Health Policy, Elsevier, vol. 99(2), pages 124-130, February.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Grant Miller & Kimberly Singer Babiarz, 2013. "Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs," NBER Working Papers 18932, National Bureau of Economic Research, Inc.
    2. Motkuri, Venkatanarayana & Khan, Amir Ullah, 2018. "Macro Economy and Health in India," MPRA Paper 84512, University Library of Munich, Germany.
    3. Bhatia, M. & Dwivedi, L.K. & Banerjee, K. & Dixit, P., 2020. "An epidemic of avoidable caesarean deliveries in the private sector in India: Is physician-induced demand at play?," Social Science & Medicine, Elsevier, vol. 265(C).
    4. Tonei, Valentina, 2019. "Mother’s mental health after childbirth: Does the delivery method matter?," Journal of Health Economics, Elsevier, vol. 63(C), pages 182-196.
    5. Dhaliwal, Iqbal & Hanna, Rema, 2017. "The devil is in the details: The successes and limitations of bureaucratic reform in India," Journal of Development Economics, Elsevier, vol. 124(C), pages 1-21.
    6. Leonard, Kenneth L. & Masatu, Melkiory C., 2010. "Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance," Journal of Development Economics, Elsevier, vol. 93(2), pages 226-234, November.
    7. Bernal, Pedro & Martinez, Sebastian, 2020. "In-kind incentives and health worker performance: Experimental evidence from El Salvador," Journal of Health Economics, Elsevier, vol. 70(C).
    8. Leone, Tiziana & Padmadas, Sabu S. & Matthews, Zoë, 2008. "Community factors affecting rising caesarean section rates in developing countries: An analysis of six countries," Social Science & Medicine, Elsevier, vol. 67(8), pages 1236-1246, October.
    9. Heather Klemick & Kenneth L. Leonard & Melkiory C. Masatu, 2007. "Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 91(2), pages 347-358.
    10. Joshua S. Gans & Andrew Leigh, 2012. "Bargaining Over Labour: Do Patients Have Any Power?," The Economic Record, The Economic Society of Australia, vol. 88(281), pages 182-194, June.
    11. Grant, Darren, 2022. "The “Quiet Revolution” and the cesarean section in the United States," Economics & Human Biology, Elsevier, vol. 47(C).
    12. Barik, Debasis & Thorat, Amit, 2015. "Issues of unequal access to public health in India," MPRA Paper 77224, University Library of Munich, Germany.
    13. Zemzem Shigute & Anagaw D. Mebratie & Robert Sparrow & Getnet Alemu & Arjun S. Bedi, 2020. "The Effect of Ethiopia’s Community-Based Health Insurance Scheme on Revenues and Quality of Care," IJERPH, MDPI, vol. 17(22), pages 1-17, November.
    14. Arrieta, Alejandro & García-Prado, Ariadna & Guillén, Jorge, 2011. "The Private Health Care Sector and the Provision of Prenatal Care Services in Latin America," World Development, Elsevier, vol. 39(4), pages 579-587, April.
    15. Das, Jishnu & Hammer, Jeffrey & Sánchez-Paramo, Carolina, 2012. "The impact of recall periods on reported morbidity and health seeking behavior," Journal of Development Economics, Elsevier, vol. 98(1), pages 76-88.
    16. Aleksandr Proshin & Alexandre Cazenave-Lacroutz & Zeynep Or & Lise Rochaix, 2018. "Impact of Diagnosis Related Group Refinement on the Choice Between Scheduled Caesarean Section and Normal Delivery: Recent Evidence from France," PSE Working Papers halshs-01812107, HAL.
    17. De Luca, Giacomo & Lisi, Domenico & Martorana, Marco & Siciliani, Luigi, 2021. "Does higher Institutional Quality improve the Appropriateness of Healthcare Provision?," Journal of Public Economics, Elsevier, vol. 194(C).
    18. Jimena Soledad Ferraro & Alan Acosta & Khare Shagun, 2021. "Physician convenience and cesarean section delivery," Asociación Argentina de Economía Política: Working Papers 4469, Asociación Argentina de Economía Política.
    19. Fabbri, Daniele & Monfardini, Chiara & Castaldini, Ilaria & Protonotari, Adalgisa, 2016. "Cesarean section and the manipulation of exact delivery time," Health Policy, Elsevier, vol. 120(7), pages 780-789.
    20. Das, Jishnu & Daniels, Benjamin & Ashok, Monisha & Shim, Eun-Young & Muralidharan, Karthik, 2022. "Two Indias: The structure of primary health care markets in rural Indian villages with implications for policy," Social Science & Medicine, Elsevier, vol. 301(C).

    More about this item

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:iim:iimawp:14595. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/eciimin.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.