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医院分娩实践的健康影响

The Health Impacts of Hospital Delivery Practices
American Economic Journal: Economic Policy · 2023 · David Card、Alessandra Fenizia、David Silver

中文摘要

不同医院的治疗实践差异很大,而且往往与患者的医疗需求关系甚微。我们评估了分娩过程中这些实践差异所产生的影响。我们发现,因准随机因素而在剖宫产率较高的医院分娩的婴儿出生时健康状况更好,再次入院的可能性更低;另有提示性证据表明,其生存状况有所改善。这些益处源于避免了可能危及婴儿健康的产程延长。相比之下,这些婴儿更有可能因呼吸系统相关问题前往急诊科就诊,这与大量观察性研究文献中剖宫产与呼吸系统健康长期受损相关联的发现一致。(JEL I11、I12、J13、J16)

Abstract

Treatment practices vary widely across hospitals, often with little connection to patients’ medical needs. We assess impacts of these differences in delivery practices at childbirth. We find that infants quasi-randomly delivered at hospitals with higher C-section rates are born in better shape and are less likely to be readmitted, with suggestive evidence of improved survival. These benefits are driven by avoidance of prolonged labors that pose risks to infant health. In contrast, these infants are more likely to visit the emergency department for respiratory-related problems, consistent with a large observational literature linking C-section to chronic reductions in respiratory health. (JEL I11, I12, J13, J16)
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