The Health Impacts of Hospital Delivery Practices
Treatment practices vary widely across hospitals, often with little connection to the medical needs of patients. We assess impacts of these differences in childbirth, where there is broad interest in reducing cesarean deliveries. Using a distance-based design and data from half a million births, we find that infants delivered at hospitals with higher c-section rates are born in better shape, are less likely to be readmitted to the hospital, are exhibit suggestive evidence of improved survival. These benefits are driven by the avoidance of prolonged labors that pose serious risks to infant health. In contrast, we document that these infants are substantially more likely to return to the emergency department for respiratory-related problems in the year after birth, providing some of the first design-based evidence consistent with a large observational literature linking cesarean delivery to chronic reductions in respiratory health.
We thank Pablo Muñoz and Alice Wu for exceptional research assistance, Pat Kline, Marit Rehavi, and Chris Walters for many detailed comments, Diane Alexander and Matt Notowidigdo for serving as discussants, Ciaran Phibbs for generous assistance with NICU classifications, and seminar participants at UC Berkeley, UC Merced, UCLA, UCSB, Princeton, GWU, NBER Summer Institute (Children), ASHEcon, and HERO for helpful comments and suggestions. We are also extremely grateful to Laura Giuliano for conversations that led to this project. Our use of the data in this project is covered under UC Berkeley Federal wide Assurance #00006252. Silver gratefully acknowledges funding from the National Institute on Aging, Grant Number T32-AG000186. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
- Rates of cesarean delivery in the United States — approximately one-third of all births — are substantially higher than in many other...