Are Some C-sections Financially Motivated?

Obstetricians perform more cesarean sections when there’s more money to make doing it, new research suggests.

The researchers determined that “doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more,” NPR says. But they also suspect that physicians aren’t doing it on purpose and that the financial incentive is subtle.

The research was conducted by health care economists Erin Johnson and M. Marit Rehavi and was published by the National Bureau of Economic Research. NPR explains:

Johnson and Rehavi decided to explore the reasons for the increased number of surgical childbirth procedures via an unusual tack: They hypothesized that obstetricians would be less likely to be swayed by financial incentives when patients themselves had significant medical expertise and knowledge. By contrast, the researchers figured, such incentives might play a larger role in medical decision-making when patients knew very little.

The study found that pregnant women are 10 percent less likely to receive a C-section if they are physicians themselves.

However, when the obstetricians were salaried, they performed more C-sections on their fellow medical professionals, who could overcome those doctors’ disincentive to perform the more time-consuming procedure.

The difference in treatment of patients disappeared when the C-section was scheduled in advance. Presumably, there’s less wiggle room for a judgment call in those situations — there’s already a known issue with vaginal delivery.

These days, about a third of American babies are delivered by C-section, compared with about a fifth in 1996, NPR says. During that period, childbirth costs have risen by $3 billion annually.