Low-risk isn't no-risk

Perinatal treatments and the health of low-income newborns

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

OriginalsprogEngelsk
TidsskriftJournal of Health Economics
Vol/bind64
Udgave nummerMarch
Sider (fra-til)55-67
ISSN0167-6296
DOI
StatusUdgivet - 1. mar. 2019

Fingeraftryk

Newborn Infant
Physicians
Health
High-Risk Pregnancy
Fetal Distress
Midwifery
Netherlands
Emergencies

Citer dette

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title = "Low-risk isn't no-risk: Perinatal treatments and the health of low-income newborns",
abstract = "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.",
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author = "Daysal, {N Meltem} and Mircea Trandafir and {van Ewijk}, Reyn",
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Low-risk isn't no-risk : Perinatal treatments and the health of low-income newborns. / Daysal, N Meltem; Trandafir, Mircea; van Ewijk, Reyn.

I: Journal of Health Economics, Bind 64, Nr. March, 01.03.2019, s. 55-67.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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

N1 - Copyright © 2019 Elsevier B.V. All rights reserved.

PY - 2019/3/1

Y1 - 2019/3/1

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 - Perinatal care

KW - Prematurity

KW - Mortality

KW - Midwives

KW - Birth

KW - Medical treatments

KW - Medical interventions

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