THE CESAREAN DECISION IN NEW-YORK-STATE, 1986 - ECONOMIC AND NONECONOMIC ASPECTS

This study describes a research project involving economic and noneconomic aspects of the cesarean decision. The study was based on a 1986 data set dealing with 68,847 obstetric deliveries in New York State excluding New York City, and had the largest number of variables known to have been assembled to analyze the cesarean decision. The authors estimated a probit multiple regression in which the dependent variable was the method of delivery. The results diverge from widely held beliefs and research findings in some areas, and are of considerable interest in other areas. Contrary to other findings, the authors did not find a relationship between date of graduation from medical school and the probability of a cesarean section. More importantly, the authors failed to find much support for the idea that obstetricians perform cesareans to enrich themselves from the additional fee income. However, our findings are consistent with the idea that obstetricians occasionally perform cesarean sections to manage their time, which does represent a form of economic self-interest. The study developed a proxy measure for fear of malpractice and found a negative relationship between fear of malpractice and cesarean section use. Finally, county cesarean rate and adjusted hospital cesarean section rate strongly and significantly influenced the probability that a given delivery is performed by cesarean section.