Do incentives, complexity and the demand for leisure explain caesarean-section deliveries?

Purpose – The purpose of this paper is to understand the determinants of quality in obstetric care and particularly why caesarean sections (CS) are experiencing unprecedented increases in developed societies. Design/methodology/approach – The paper exploits a population-based database containing records on the determinants of CS to study the effects of hospital complexity and private financing and controlling for clinical and social determinants. The data refer to the entire population deliveries data from year 2003 as collected by the Catalan Health Service (Conjunt Mínim de Base de Dades). This paper employs multivariate statistical analysis and it distinguishes between total, programmed and non-programmed deliveries. Findings – Privately financed hospitals and hospital complexity are significant determinants of the probability of a CS. Overall, the paper finds significant clinical variability between public and private hospitals. The significance of mother's age suggests that the delay in the motherhood is more likely to increase the probability of a CS in public hospital deliveries while it is not the case of private hospitals. It finds that demand for leisure and capacity explains CS in public hospitals but not in private hospitals. Practical implications – Quality of care is influenced by reimbursement mechanism along with provider complexity, which suggests that there is scope for improvement in providers pay per intervention. Originality/value – The nature of the data and methods.