The effect of physician characteristics on clinical behavior: Cesarean section in New York State

Tussing, A. Dale; Wojtowycz, Martha A.

doi:10.1016/0277-9536(93)90336-3

Cited by 54 publications

(24 citation statements)

References 18 publications

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“…Staff/clinic physicians and a small number of non-obstetricians were also removed from the sample, in effect controlling for these variables as well. The coefficients, though generally insignificant, were similar to those in previous work [42,43]. Notably, these variables explained less than 12% of the variation in physician cesarean propensities; the remaining (unexplained) variation in physician cesarean propensities had a standard deviation of 5.85 percentage points.…”

Section: Resultssupporting

confidence: 80%

Information and sorting in the market for obstetrical services

Grant

2005

Health Econ.

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Using a statistical model and a partial equilibrium economic search model, we develop a methodology for appraising the value of consumer information about the quality of health care providers and apply it to information about physicians' predispositions to perform cesarean section deliveries. There are three primary results. First, information's value is roughly proportional to a simple statistical metric of its accuracy; the constant of proportionality can be imputed from knowledge of consumer search methods and consumer preferences. Second, the function governing the production of information from data 'inputs' can have surprising economic properties, such as economies of scale, that usefully inform the efficient production of consumer information. These properties are robust even when the value of information cannot be precisely determined. Third, information's value is enhanced by the way physicians are sorted into hospitals but greatly attenuated by the presence of other dimensions of physician heterogeneity. Under plausible assumptions, the value of information in our empirical application is small enough that it is not surprising that consumers do not utilize it when selecting a physician.

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Section: Resultssupporting

confidence: 80%

Information and sorting in the market for obstetrical services

Grant

2005

Health Econ.

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“…This result deserves more in-depth qualitative research on such differences. Various studies indicate the effects of obstetrician's characteristics on type of delivery 10,11,30,31,32,33 , but we found only two 34,35 with an independent association between male gender and increased odds of cesarean.…”

Section: Discussioncontrasting

confidence: 67%

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

et al. 2006

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Brazil has one of the world's highest cesarean section rates. Contributing factors include the organization of obstetric practice, physicians' attitudes, and women's preferences and decisions. This study aimed to identify factors associated with cesarean sections in a public maternity hospital in Rio de Janeiro. A case-control study was conducted with 231 cesarean sections (cases) and 230 vaginal deliveries (controls). Hierarchical logistic regression analysis was performed, based on a conceptual model. Factors associated with increased odds of cesarean section were: primiparity; mother's age 20-34; last birth by cesarean; cervical dilatation < 3cm at admission; patient request; daytime birth; male attending obstetrician; obstetrician on duty for more than 24 hours a week; obstetrician with private practice; gestational hypertension; non-cephalic presentation; and gestational age > 41 weeks. Factors associated with lower odds of cesarean were: gestational age < 37 weeks; leaving home with signs of labor, use of oxytocin; and amniotomy. In this hospital, interventions aimed to modify the above-mentioned factors can help lower the cesarean rate.

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“…From the history of the workers' movement in Europe and as the recent evolution in a number of middle-income countries – such as Thailand's National Forum on Health Care Reform [128] – points out, perhaps the most effective way to help the State regulate professional practice is to increase pressure from civil society. (Fear of malpractice may have a paradoxical effect in that may result in excessive and inappropriate recourse to caesarean sections, for example [85,129]. )…”

Section: Dual Practicementioning

confidence: 99%

Dual practice in the health sector: review of the evidence

et al. 2004

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This paper reports on income generation practices among civil servants in the health sector, with a particular emphasis on dual practice. It first approaches the subject of public–private overlap. Thereafter it focuses on coping strategies in general and then on dual practice in particular.To compensate for unrealistically low salaries, health workers rely on individual coping strategies. Many clinicians combine salaried, public-sector clinical work with a fee-for-service private clientele. This dual practice is often a means by which health workers try to meet their survival needs, reflecting the inability of health ministries to ensure adequate salaries and working conditions.Dual practice may be considered present in most countries, if not all. Nevertheless, there is surprisingly little hard evidence about the extent to which health workers resort to dual practice, about the balance of economic and other motives for doing so, or about the consequences for the proper use of the scarce public resources dedicated to health.In this paper dual practice is approached from six different perspectives: (1) conceptual, regarding what is meant by dual practice; (2) descriptive, trying to develop a typology of dual practices; (3) quantitative, trying to determine its prevalence; (4) impact on personal income, the health care system and health status; (5) qualitative, looking at the reasons why practitioners so frequently remain in public practice while also working in the private sector and at contextual, personal life, institutional and professional factors that make it easier or more difficult to have dual practices; and (6) possible interventions to deal with dual practice.

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The effect of physician characteristics on clinical behavior: Cesarean section in New York State

Cited by 54 publications

References 18 publications

Information and sorting in the market for obstetrical services

Information and sorting in the market for obstetrical services

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

Dual practice in the health sector: review of the evidence

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