What is Pushing Brazil Not to Push?
Nobrega, Juliana K.
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C-section rates have been increasing worldwide, but this concern is immediate in Brazil – the country with the highest C-section rate. This thesis investigates the reasons behind the high rates of C-section in Brazil, focusing on incentives along three dimensions. The incentive related to physicians demand for leisure and birth timing, the incentive related to information and physicians preferences and the financial incentive from performing C-sections. I also develop a utility model that emphasizes the high opportunity costs from natural births faced by physicians and while incorporating the role of patients preferences. Using national-wide data, I find that physicians take advantage of the scheduling properties of C-section to shift births away from more desired leisure times. Regarding physicians preferences, I compare birth choices among physicians and non-physicians mothers. Contrasting with previous findings, I show that Brazilian physicians undergo a C-section more often than other well-educated patients. I also exploit the effect of C-section on infant health outcomes. Finally, regarding financial incentives, I study a government policy that altered reimbursement fees for births by increasing the real fee for C-section. I find that physicians responded to this change by performing relatively more C-sections while controlling for groups unaffected by the policy change. In countries where there is low quality regarding natural births and high opportunity costs faced by physicians from performing such procedure, trade-offs are different than the ones arising in North America and emphasized in traditional models of Supplier-Induced Demand.