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

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  • 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
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    References listed on IDEAS

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    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. Planning Commission, 2011. "High Level Expert Group Report on Universal Health Coverage for India," Working Papers id:4646, eSocialSciences.
    8. 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.
    9. 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.
    10. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    11. 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.
    12. 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.
    13. 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.
    14. 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.
    15. 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.
    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.
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