Disentangling Sources of Variation in C-Section Rates / Stefanie J. Fischer, Shuhei Kaneko, Heather Royer, Corey D. White.

Format:

Book

Author/Creator:

Fischer, Stefanie J.

Contributor:

Kaneko, Shuhei.

Royer, Heather.

White, Corey D.

National Bureau of Economic Research.

Series:

Working Paper Series (National Bureau of Economic Research) no. w34469.

NBER working paper series no. w34469

Language:

English

Physical Description:

1 online resource: illustrations (black and white);

Place of Publication:

Cambridge, Mass. National Bureau of Economic Research 2025.

Summary:

Cesarean section rates vary widely across U.S. counties, yet it remains unclear how much of this variation reflects demand-side factors (such as patient risk or preferences) versus supply-side factors (such as physician practices or hospital incentives). We develop a new empirical strategy to isolate the influence of supply-side forces. Exploiting hospital obstetric unit closures from 1989-2019 that reallocate some mothers to counties with different C-section rates, we find that a one-percentage-point increase in the delivery county's rate raises a mother's likelihood of a C-section by roughly one point. The results point to a dominant role for provider behavior and local practice norms in driving geographic variation in C-section use, the most common major surgery in the United States.

Notes:

November 2025.

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