Easy Like Sunday Morning: Organizational Design and Physician Agency in Birth Timing

Jimena S. Ferraro (), Raul A. Sosa () and Franco M. Vazquez ()
Additional contact information
Jimena S. Ferraro: Universidad de San Andrés
Raul A. Sosa: Universidad de San Andrés
Franco M. Vazquez: Universidad de San Andrés

No 184, Working Papers from Universidad de San Andres, Departamento de Economia

Abstract: Cesarean rates differ sharply between private and public hospitals in Buenos Aires, even though payments do not vary with delivery mode in either sector. We argue this gap reflects organizational design rather than procedure prices. In the Buenos Aires metropolitan area, individualized private and team-based public maternity care coexist within the same labor market. Using ex ante preferences and medical records for low-risk first-time mothers, we document a preference margin and a timing margin. Stated preferences for cesarean predict scheduled procedures strongly in private hospitals and not at all in public ones. Elective cesareans in private hospitals cluster on boundary working days (the Monday or Friday adjacent to a weekend or holiday), and the intrapartum cesarean rate is about 13 percentage points higher on working than nonworking days in private hospitals, but indistinguishable from zero in public ones, a gradient that reflects selection induced by the timing margin. A simple model rationalizes both margins through the opportunity cost of physician time, internalized only when physicians are residual claimants of their own schedule. Organizational design, not procedure prices, is the primary lever behind the discretionary component of cesarean use.

Keywords: cesarean section; physici anagency; organizational design; birth timing; maternity care; mixed health systems. (search for similar items in EconPapers)
JEL-codes: I11 I18 J22 J44 L23 (search for similar items in EconPapers)
Pages: 61 pages
Date: 2026-07, Revised 2026-07
References: Add references at CitEc
Citations:

Downloads: (external link)
https://repec.udesa.edu.ar/pub/econ/doc184.pdf First version, July 2026 (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sad:wpaper:184

Access Statistics for this paper

More papers in Working Papers from Universidad de San Andres, Departamento de Economia Contact information at EDIRC.
Bibliographic data for series maintained by Economia ().