Hospital choice, C-sections, and long-term maternal health

Ramiro de Elejalde and Eugenio Giolito

Working Papers Central Bank of Chile from Central Bank of Chile

Abstract: We study the causal effect of delivering in a private rather than a public hospital on maternal outcomes in Chile. We exploit a 2003 copayment reduction that expanded access to private hospitals for women insured by the public system as an instrument for private delivery. Combining administrative birth records with hospital discharge data, we estimate an IV difference-in-differences model that follows mothers for up to fifteen years after the first birth. Private hospital delivery improves short-term outcomes, reducing prolonged hospitalizations and 30-day readmissions. These gains are offset by worse long-term outcomes: women induced to deliver in private hospitals face higher risks of repeat C-sections, cesarean-scar complications, and hysterectomy, with no effects on subsequent fertility. The results highlight a trade-off between short-run improvements in observable outcomes and long-run maternal health risks generated by organizational practices that encourage planned cesarean delivery.

Date: 2026-04
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Persistent link: https://EconPapers.repec.org/RePEc:chb:bcchwp:1079

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