Association for Public Policy Analysis & Management

This project tests how resource availability affects health care providers’ clinical decision making and their patients’ health outcomes in the context of childbirth care. Childbirth provides an ideal context for studying this relationship because (1) resource needs can be defined by a specific and discrete event—the date and time of birth; (2) these resource needs vary dynamically and often unpredictably; (3) hospital labor floor beds are a critical, and relatively fixed hospital resource in the short term; and (4) cesarean deliveries provide a (discretionary) means of making bed resources more available on labor and delivery units in a fairly predictable timeframe. While cesareans are a life-saving measure in some cases, overuse can expose the mother and baby to unnecessary health risks. We analyzed birth certificate records linked with hospital inpatient claims, from Philadelphia over 1995-2010, to predict the impact of each additional overlapping patient in the 6 hours prior to birth on childbirth care utilization and health outcomes. Overlapping patients are defined as those whose time between admission and delivery overlapped at any time with the six hours prior index case’s own time of delivery (or entire time between admission and delivery if shorter than six hours). The overall rate of cesarean deliveries over the study period was 25.1%, ranging from 12.9 to 30.2% at the hospital level. All else equal, an individual woman was 0.5 percentage points more likely to have a cesarean for every additional overlapping patient on the labor floor during the six hours prior to her delivery, an effect that is similar in magnitude to aging 0.5-1 years.