Non-elective cesarean sections in public hospitals: hospital capacity constraints and doctor´s incentives

Using administrative records of births from the Perinatal Surveillance System of the Social Security System (ESSALUD) in Peru, we test whether high admissions of pregnant women affected unplanned cesarean section rates in the ESSALUD public hospitals during the period 2005-2006. To this purpose, we present a basic theoretical model that considers not only physician preference for leisure but also the effect of hospital capacity constraints. Based on inferences of this model, we find that physician demand for leisure increases the probability of a c-section in the smallest hospitals, while hospital constraints set a limit on the number of cesarean sections that can be performed. We discuss the policy implications of our findings and the policies implemented in ESSALUD to monitor the quality of obstetric services and avoid unnecessary or unjustified c-sections.