TY - JOUR

T1 - Low-risk isn't no-risk

T2 - Perinatal treatments and the health of low-income newborns

AU - Daysal, N. Meltem

AU - Trandafir, Mircea

AU - van Ewijk, Reyn

PY - 2019/3

Y1 - 2019/3

N2 - We investigate the effects of perinatal medical treatments on low-income newborns who are classified as low-risk. A policy rule in The Netherlands states that low-risk deliveries before week 37 should be supervised by physicians and later deliveries only by midwives with no physician present. This creates large discontinuities in the probability of receiving medical interventions only physicians are allowed to perform. Using a regression discontinuity design, we find that babies born slightly before the week-37 cutoff are significantly less likely to die than babies born slightly later. Our data suggest that physician supervision of birth reduces the likelihood of adverse events such as fetal distress or emergency C-section. Our results indicate that low-income women benefit from receiving a higher level of medical care even if no explicit risk factors have been recognized, pointing to challenges in identifying all high-risk pregnancies. “Back-of-the-envelope” calculations suggest this additional care is highly cost-effective.

AB - We investigate the effects of perinatal medical treatments on low-income newborns who are classified as low-risk. A policy rule in The Netherlands states that low-risk deliveries before week 37 should be supervised by physicians and later deliveries only by midwives with no physician present. This creates large discontinuities in the probability of receiving medical interventions only physicians are allowed to perform. Using a regression discontinuity design, we find that babies born slightly before the week-37 cutoff are significantly less likely to die than babies born slightly later. Our data suggest that physician supervision of birth reduces the likelihood of adverse events such as fetal distress or emergency C-section. Our results indicate that low-income women benefit from receiving a higher level of medical care even if no explicit risk factors have been recognized, pointing to challenges in identifying all high-risk pregnancies. “Back-of-the-envelope” calculations suggest this additional care is highly cost-effective.

KW - Birth

KW - Medical interventions

KW - Medical treatments

KW - Midwives

KW - Mortality

KW - Perinatal care

KW - Prematurity

U2 - 10.1016/j.jhealeco.2019.01.006

DO - 10.1016/j.jhealeco.2019.01.006

M3 - Journal article

C2 - 30797113

AN - SCOPUS:85061713761

VL - 64

SP - 55

EP - 67

JO - Journal of Health Economics

JF - Journal of Health Economics

SN - 0167-6296

ER -