Department of Economics
2115 G Street NW
George Washington University
Washington, DC 20052
Institutional Affiliation: University of California at Berkeley
NBER Working Papers and Publications
|June 2019||The Health Impacts of Hospital Delivery Practices|
with David Card, David Silver: w25986
Hospital treatment practices vary widely, often with little connection to the medical needs of patients. We assess the impact of these differences in the context of childbirth. We focus on low-risk first births, where cesarean delivery rates vary enormously across hospitals, and where policymakers have focused much of their attention in calls for reducing unnecessary c-sections. We find that proximity to hospitals with high c-section rates leads to more cesarean deliveries, fewer vaginal births after prolonged labor, and higher average Apgar scores. Infants whose mothers’ choice of a high c-section hospital is attributable to distance are more likely to visit the emergency department for a respiratory-related problem in the year after birth but are less likely to be readmitted to hospital....
|April 2018||The Health Effects of Cesarean Delivery for Low-Risk First Births|
with David Card, David Silver: w24493
Cesarean delivery for low-risk pregnancies is generally associated with worse health outcomes for infants and mothers. The interpretation of this correlation, however, is confounded by potential selectivity in the choice of birth mode. We use birth records from California, merged with hospital and emergency department (ED) visits for infants and mothers in the year after birth, to study the causal health effects of cesarean delivery for low-risk first births. Building on McClellan, McNeil, and Newhouse (1994), we use the relative distance from a mother’s home to hospitals with high and low c-section rates as an instrument for c-section. We show that relative distance is a strong predictor of c-section but is orthogonal to many observed risk factors, including birth weight and indicators...