Similar children, dissimilar deliveries? The importance of patient information

Presenter:

Abstract

Background:

Asymmetric information between physicians and patients can lead to inefficiencies in health care provision. As a result of this asymmetry too many or too few services may be supplied. It is difficult to assess which is the “correct level” of sevices. Research has not provided a clear answer to this question, due to a lack of data about what treatment a fully informed patient would choose. In the present study, we have access to this type of data from the Medical Birth Registry of Norway.

Objectives:

The objective of the study is to examine whether type of delivery (Caesarean delivery versus normal delivery) varies according to whether parents are fully informed, partially informed, or slightly informed about the medical aspects of type of delivery.

Methodology:

Since 1967, all births in Norway have been registered consecutively in the Medical Birth Registry of Norway. The data file covers a period of 40 years and contains information about 2.4 million births, including whether the birth was a normal delivery or a Caesarean delivery. Data from the Medical Birth Registry were merged with data from the Register of Education. We classified all parents according to whether they were specialists in obstetrics and gynaecology (fully informed), physicians, dentists, nurses or midwives (partially informed), or whether they had other types of education (slightly informed).

The register also contains medical and demographic data about the mother, the father and the child. Factors that may be indications for Caesarean section include foetal position, the weight of the baby, pre-eclampsia, certain diseases in the mother, the age of the mother, previous Caesarean section and multiple births. The medical and demographic variables were used as control variables in the empirical analyses. The data were analysed using binary logistic regression analysis.

Results:

Preliminary analyses show that there is a significantly higher probability that a child will be born by Caesarean section if the mother or father is an obstetrician or gynaecologist, compared to if the mother or father belongs to one of the other groups. There was no difference between the partially-informed and slightly-informed groups.

Conclusion:

Only fully-informed parents (those who are obstetricians or gynaecologists) can influence type of delivery. However, this group makes up a very small proportion of all parents. Parents who are partially-informed or slightly informed may also possibly exert some pressure on the physician about the type of delivery they desire. But our results indicate that if they do exert pressure, the specialists are able to withstand this pressure.