title: The effect of physicians' remuneration system on the Caesarean section rate: the Uruguayan case.
abstract: Using data about births from the perinatal information system (PIS) registered in Montevideo (Uruguay), we estimated the probability of having a Caesarian section delivery, controlled by risk factors and the endogeneity of the choice of hospital. In public hospitals in Montevideo there is a fixed payment system, but in private hospitals this procedure has to be paid for separately. In the former, there is no effect on the doctor's income if he performs a Caesarian, but in the latter there is a positive effect. Empirical evidence shows the probability of a Caesarean section increases with the age of the woman, the presence of eclampsy, pre-eclampsy, previous hypertension, previous Caesarean sections, multiple pregnancies and fetopelvic disproportion, and decreases for multiparous women and women in a public hospital. In fact, the probability of having a Caesarean section in a private institution is almost two times higher than in a public hospital (20% as against 39%). Focusing on women without risk factors, we found that the probability a Caesarian in a public hospital was 11%, but the probability in a private hospital was 25%. We conclude that the remuneration system explains an important part of this difference.
authors.affiliation: Department of Economics, School of Social Sciences, University of the Republic, Montevideo, Uruguay. patricia@decon.edu.uy
authors.forename: Patricia
authors.initials: P
authors.lastname: Triunfo
authors.forename: Máximo
authors.initials: M
authors.lastname: Rossi
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D016304:Hospitals, Private / Q000191:economics / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D010820:Physicians / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D060926:Remuneration; D012307:Risk Factors; D014583:Uruguay / Q000453:epidemiology; D055815:Young Adult