We examine the contribution of information transmission among pregnant women to geographic variation in C-sections in Lombardy, Italy. Defining networks as pregnant women living in the same municipality, we observe that if the incidence of C-sections within the womans network is one standard deviation higher over the 12 months preceding delivery, then her probability of delivering by C-section is 0.007 percentage points (3%) higher. This result is mainly a network effect on Italian women, while it arises from both network and neighborhood effects on foreign women. Both groups respond to additional information, such as the incidence of C-section complications. The selection of pregnant women across hospitals does not uniquely explain our results, which are robust to alternative sample selections and specifications.

• MeSH
• císařský řez * MeSH
• incidence MeSH
• lidé MeSH
• nemocnice * MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Itálie MeSH

We assess the impact of prenatal care on health at birth using birth certificates from the Czech Republic. We use a predictive machine learning algorithm to identify the observables affecting birth health outcomes. We control for those observables in our empirical analysis, which indicates that a more intense use of prenatal care is positively correlated with better health outcomes at birth. Exploiting the Czech adhesion to the EU in 2004, we construct an instrument to capture the geographical heterogeneous access to prenatal care across districts. Differently from the OLS results, the IV results do not capture any significant effect of prenatal care, leaving room for the hidden role of unobservable mothers' characteristics when it comes to health behaviors during pregnancy.

• MeSH
• lidé MeSH
• novorozenec MeSH
• prenatální péče * MeSH
• těhotenství MeSH
• zdravé chování * MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Fee equalization in health care brings under a unique tariff several medical treatments, coded under different Diagnosis Related Groups (DRGs). The aim is to improve healthcare quality and efficiency by discouraging unnecessary, but better-paid, treatments. We evaluate its effectiveness on childbirth procedures to reduce overuse of c-sections by equalizing the DRGs for vaginal and cesarean deliveries. Using data from Italy and a difference-in-differences approach, we show that setting an equal fee decreased c-sections by 2.6%. This improved the appropriateness of medical decisions, with more low-risk mothers delivering naturally and no significant changes in the incidence of complications for vaginal deliveries. Our analysis supports the effectiveness of fee equalization in avoiding c-sections, but highlights the marginal role of financial incentives in driving c-section overuse. The observed drop was only temporary and in about a year the use of c-sections went back to the initial level. We found a greater reduction in lower quality, more capacity-constrained hospitals. Moreover, the effect is driven by districts where the availability of Ob-Gyn specialists is higher and where women are predominant in the gender composition of Ob-Gyn specialists.

• MeSH
• císařský řez * MeSH
• lidé MeSH
• poskytování zdravotní péče * MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Itálie MeSH

Road traffic accidents mean lost productivity and medical expenditures. We explain trends in traffic accidents as a function of the political cycle using municipal data from Italy. We show that during municipal election years, the accident rate increases by 1.5%, with a 2% increase in the injury rate but no effect on the fatality rate. The effects are stronger in the quarter prior to the election quarter, when the electoral campaign is at its zenith, and in the second quarter after the election for the new elected mayor. We show that this is the result of a decrease in tickets for traffic violations (rate and revenues) during election years. Our results are robustly driven by the municipal political cycle defined in different ways, and their magnitude and direction are not explained by the spillover effects between municipalities. Proximity to a national police station reduces the impact of local elections on injury rates.

• MeSH
• dopravní nehody * MeSH
• lidé MeSH
• velkoměsta MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Itálie MeSH
• velkoměsta MeSH

Using data from Spain, we show the impact of significant health-sector budget cuts introduced in 2012 on the rates of cesarean sections and on infant health outcomes at birth, which we use as a proxy for the quality of birth centers. Exploiting a difference-in-differences fixed-effects approach at the hospital level, we estimate a 3% increase in C-sections as a result of the budget restrictions, with no significant consequences on health outcomes at birth. Given the additional evidence in the literature on the negative short- and long-term effects of non-medically indicated C-sections, our paper provides important policy implications for population health.

• MeSH
• císařský řez * MeSH
• kojenec MeSH
• lidé MeSH
• porod * MeSH
• rozpočty MeSH
• těhotenství MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Španělsko MeSH

A well-established political economic literature has shown as multi-level governance affects the inefficiency of public expenditures. Yet, this expectation has not been empirically tested on health expenditures. We provide a political economy interpretation of the variation in the prices of 6 obstetric DRGs using Italy as a case study. Italy offers a unique institutional setting since its 21 regional governments can decide whether to adopt the national DRG system or to adjust/waive it. We investigate whether the composition and characteristics of regional governments do matter for the average DRG level and, if so, why. To address both questions, we first use a panel fixed effects model exploiting the results of 66 elections between 2000 and 2013 (i.e., 294 obs) to estimate the link between DRGs and the composition and characteristics of regional governments. Second, we investigate these results exploiting the implementation of a budget constraint policy through a difference-in-differences framework. The incidence of physicians in the regional government explains the variation of DRGs with low technological intensity, such as normal newborn, but not of those with high technological intensity, as severely premature newborn. We also observe a decrease in the average levels of DRGs after the budget constraint implementation, but the magnitude of this decrease depends primarily on the presence of physicians among politicians and the political alignment between the regional and the national government. To understand which kind of role the relevance of the political components plays (i.e., waste vs. better defined DRGs), we check whether any of the considered political economy variables have a positive impact on the quality of regional obstetric systems finding no effect. These results are a first evidence that a system of standardized prices, such as the DRGs, is not immune to political pressures.

• MeSH
• financování zdravotní péče MeSH
• klasifikační systém DRG ekonomika   trendy   MeSH
• lidé MeSH
• politika * MeSH
• rozpočty statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Itálie MeSH

We provide a new assessment of the effect of hospital proximity in an emergency situation-road-traffic accidents-exploiting the exogenous variation in the proximity to cities that are legally allowed to have a hospital on the basis of their population size. Our instrumental variable results show that a one-standard-deviation increase in the distance to the nearest hospital (5 km) raises the fatality rate by 13.84% at the sample average. This figure is equal to 0.92 additional deaths per 100 accidents. We show that both ordinary least squares and difference-in-differences estimates, common approaches in the literature, provide a downward-biased measure of the true effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity is more important when the level of road safety is low, when emergency services are less responsive, and when the nearest hospital has relatively low quality standards.

• MeSH
• dopravní nehody mortalita   MeSH
• hustota populace MeSH
• lékaři statistika a číselné údaje   MeSH
• letecká záchranná služba statistika a číselné údaje   MeSH
• lidé MeSH
• prostorová analýza MeSH
• sanitky statistika a číselné údaje   MeSH
• socioekonomické faktory MeSH
• urgentní služby nemocnice statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Itálie epidemiologie   MeSH

• MeSH
• chybná zdravotní péče MeSH
• právní odpovědnost MeSH
• právní vědy MeSH
• zdravotní politika MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• politologie, politika, zdravotní politika
• NLK Publikační typ
• studie

Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7-11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream skimming.

• MeSH
• císařský řez statistika a číselné údaje   MeSH
• dospělí MeSH
• ekonometrické modely MeSH
• lékařská praxe - způsoby provádění ekonomika   statistika a číselné údaje   MeSH
• lidé MeSH
• pojištění zákonné odpovědnosti ekonomika   statistika a číselné údaje   MeSH
• porodnictví ekonomika   normy   statistika a číselné údaje   MeSH
• těhotenství MeSH
• výsledek těhotenství ekonomika   epidemiologie   MeSH
• zanedbání povinné péče ekonomika   statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Itálie MeSH