Obstetricians are more likely to perform time-consuming cesarean sections when there is a financial incentive to be gained, according to a new study.
In 1996, one in five babies was delivered via C-section. Today one in three babies are delivered through surgical childbirth. From 1996 to 2013, the cost of childbirth in the U.S. has grown $3 billion annually, according to NPR.
Study authors and health care economists Erin Johnson and M. Marit Rehavia found that when an obstetrician is paid a flat rate with no incentive to perform surgery, they give fewer C-sections. They estimated that doctors might see a couple extra hundred dollars and hospitals a few thousand more dollars in the event a c-section is done.
Johnson and Rehavia wondered if obstetricians would back off pushing for a c-section if they had a patient with significant medical expertise and knowledge. They decided to compare the birthing method for patients who knew little about health and those patients who were themselves physicians.
"The idea is that physicians have medical knowledge," said Johnson. "If the obstetrician is deviating from the best treatment because of their own financial incentive, the patient [who is a] doctor would be able to not have the medical knowledge to know whether or not this C-section is the appropriate [method of delivery] for them."
Pregnant physicians weren’t getting as many c-sections, when pay incentives were present.
"We found that doctors are about 10 percent less likely to get C-sections," Johnson said. "So obstetricians appear to be treating their physician patients differently than [they treat] their nonphysician patients."
When the C-section was scheduled in advance, however, the rates were the same between between physicians and nonphysician mothers.
The number of C-sections dropped off for physicians, when it was an “emergency,” for instance when labor isn’t going well. This is when a doctor has to make the decision to either continue labor or abandon the process and deliver the baby surgically.
Johnson and Rehavia said their research, published by the National Bureau of Economic Research, emphasizes the important of patient knowledge and empowerment.