BI Open: The impact of hospital revenue on the increase in Caesarean sections in Norway. A panel data analysis of hospitals 1976-2005
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The impact of hospital revenue on the increase in Caesarean sections in Norway. A panel data analysis of hospitals 1976-2005
Grytten, Jostein Ivar; Monkerud, Lars Christian; Hagen, Terje P.; Sørensen, Rune Jørgen; Eskild, Anne; Skau, Irene
Journal article, Peer reviewed
Åpne
Monkerud_Sørensen_ BMCHSR_2011.pdf (273.4Kb)
Permanent lenke
http://hdl.handle.net/11250/93580
Utgivelsesdato
2011
Metadata
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Scientific articles [1786]
Originalversjon
http://dx.doi.org/10.1186/1472-6963-11-267
Sammendrag
Background: There has been a marked increase in the number of Caesarean sections in many countries during
the last decades. In several countries, Caesarean sections are carried out in more than 20 per cent of births. These
high Caesarean section rates give cause for concern, both from an economic and a medical perspective. A general
opinion among epidemiologists is that the increase in the number of Caesarean sections during the last decade
has been greater than could be expected in relation to medical risk factors. Therefore, other explanations must be
sought. We studied one potential explanation; the effect that the increase in hospital revenue per bed during the
period 1976-2005 has had on the Caesarean section rate in Norway. During this period, hospital revenue increased
by about 260% (adjusted for inflation).
Methods: The analyses were carried out using data from the Medical Birth Registry 1976-2005 from Norway. The
data were merged with data about hospital revenue, which were obtained from Statistics Norway. The analyses
were carried out using annual data from 46 hospitals. A fixed effect regression model was estimated. Relevant
medical control variables were included.
Results: The elasticity of the Caesarean section rate with respect to hospital revenue per bed was 0.13 (p < 0.05).
This represents an increase in the Caesarean section rate from the basis year 1976 to the final year 2005 of about
35 per cent. Most of the variables measuring characteristics of the health status of the mother and child had the
expected effects.
Conclusion: The increase in hospital revenue explains only a small part of the increase in the Caesarean section
rate in Norway during the last three decades. The increase in the Caesarean section rate is considerably greater
than could be expected, based on the increase in hospital revenue alone. The strength of our study is that we
have estimated a cause and effect relationship. This was done by using fixed effects for hospitals, a lagged revenue
variable and by including an extensive set of control variables for the risk factors of the mother and the baby.
Beskrivelse
Dette er et Open Access tidsskrift. Publisert versjon tilgjengelig på http://www.biomedcentral.com/
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BioMed Central
Tidsskrift
BMC Health Services Research
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