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.
More midwives, fewer doctors: a safe way to cut medical costs?
IZA Discussion Paper No. 7834 Returns to Childbirth Technologies: Evidence from Preterm Births
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