Association for Public Policy Analysis & Management

Several nationwide policies aimed at improving perinatal health have been implemented in the Netherlands, but little is known about their impact on perinatal outcomes and their capability to reduce health—income inequalities. We exploit one of these policies – a change in the remuneration received by midwives working in deprived areas- and assess its effects on health outcomes.

Midwives working with mothers who live in neighbourhoods over a given level of deprivation were entitled to an increased fee obtained per woman cared for, while the same midwives would only receive the standard fee for mothers living in non-deprived areas. We overcome the presence of a confounding policy using the same cut-off point by using a difference-in-discontinuity approach. More precisely, we exploit a discontinuity along deprivation scores before and after the policy was introduced, to isolate the causal effect of additional remuneration on birth outcomes.

We observe modest health improvements in foetal growth as a result of the additional remuneration. These increases in birthweight, are especially remarkable for those at the bottom of the weight distribution. We show these gains are driven by a more accurate risk detection during the prenatal period, as well as increased collaboration between the different healthcare providers.