Tussing AD, Wojtowycz MA; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented By: A. Dale Tussing, Ph.D., Professor of Economics, Syracuse University, Syracuse, NY, 13244. Tel: 315-443-2642; Fax: 315-443-3717; E-mail: tussing@syr.edu.
Research Objective: The cesarean section rate rose throughout the 1960s, 1970s, and 1980s, peaking in about 1988 before leveling off and declining slightly. The period 1986-1996 was one of considerable interest in obstetric behavior and c-sections in particular. The authors, who conducted a study of c-sections and obstetric behavior using 1986 New York State data, have begun a project to study changes between 1986 and 1996 in the behavior of the system and in demographic and other values (corresponding to parameters and variables of the system) in relation to method of obstetric delivery. This presentation is part of that project. It investigates determinants of changes in c-section rates of physicians with least 50 deliveries in both 1986 and 1996. The purpose is to determine the extent to which changes in cesarean delivery rates are the consequence of changes in the behavior of individual providers, and to understand the sources of that behavior change.Study Design: Data are from merged vital statistics and hospital discharge records for 1986 and 1996 for New York State outside of New York City. The dependent variable in logistic regressions is change in individual physician c-section rates (overall; repeat; primary) between those years, for providers with at least 50 deliveries in each year. The data present an opportunity to study influences on changes in individual provider behavior, in what virtually amount to longitudinal data. Independent variables include birth characteristics (prenatal care; complications of pregnancy, labor, and delivery; plurality; etc.) maternal characteristics (age, race, previous obstetric history, etc.); county characteristics (urban/rural, ratio of obstetricians to fertile-aged females, etc.); hospital characteristics (size; ownership; level; etc.); physician characteristics (gender; age or experience; board certified obstetrician; etc.); and payer type (indemnity insurance: HMO; PPO; etc. ). No individual physician data are reported.Principal Findings: The change in individual physician c-section rates is not fully explained by the independent variables. There is an unexplained residual reflecting change in physician behavior over the 10-year period. This change in behavior can reflect either the ordinary maturation process or the effects of the unique environment of the period on obstetric behavior. In further research, we will evaluate how each of these explains observed behavior, by looking at cross-sectional age/experience influences on cesarean behavior in both 1986 and 1996, and by comparing the unexplained changes in physician c-section rates with changes in behavior of the overall system.Implications for Policy, Delivery or Practice: While we can observe the levels and rates of change of such variables as the c-section rate, these aggregate variables are the consequence of complex underlying changes in, for example, the ages of mothers, the gender distribution of physicians, the distribution of payer types, and other values in the system. To make intelligent policy in relation to c-section (and, by extension, other types of medical care), it is important to distinguish between the behavior of the system and the values of variables. Primary Funding Source: AHRQ (Agency for Healthcare Research and Quality).
Publication Types:
Keywords:
- Cesarean Section
- Delivery, Obstetric
- Female
- Foreign Medical Graduates
- Health Maintenance Organizations
- Humans
- Insurance, Health
- Logistic Models
- Mothers
- New York
- New York City
- Obstetric Labor Complications
- Physicians
- Physicians, Women
- Pregnancy
- Pregnancy Complications
- Prenatal Care
- economics
- surgery
- hsrmtgs
Other ID:
UI: 102272172
From Meeting Abstracts