More midwives, fewer doctors: a safe way to cut medical costs?

Medical expenditures increased tremendously over the last few decades throughout the entire developed world. This is especially true for spending on newborns. Against this backdrop, a new IZA Discussion Paper by N. Meltem Daysal, Mircea Trandafir and Reyn van Ewijkand assesses the potential to save medical costs by investigating the impact of doctor supervision – as opposed to midwife supervision – on the short-term health of low-risk newborns in the Netherlands. The Dutch system is unique in its division between the primary care provided by midwives and the secondary care provided by gynecologists/obstetricians (OB/GYN). Women without known medical risk factors start their pregnancy under the supervision of a midwife and stay under the supervision of a midwife as long as no additional risk factors appear. Midwives, who are prohibited by law from performing any medical intervention, also supervise the delivery where no OB/GYN is present. However, if labor is premature, that is before 37 completed gestational weeks, women should be sent to a doctor who will supervise the delivery. This “week-37 rule” generates a discontinuity in the probability of being treated by an OB/GYN at gestational week 37 among low-risk women. Exploiting this cut-off, the authors find no positive health benefits for the newborn due to the supervision of an OB/GYN, although the rates of neonatal intensive care unit admissions among births supervised by obstetricians increased. These results indicate potential cost savings from increased use of midwifery care for low-risk deliveries. Hence, the findings are relevant to the ongoing policy debates on cost reduction through increased use of physician extenders as a growing number of women in developed countries are giving birth with a midwife.