The Effect of Maternity Ward Closures on Physician’s Practice and Health Outcomes in Japan

Akifumi Kusano (), Haruko Noguchi and Yichen Shen
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Akifumi Kusano: Graduate School of Economics, Waseda University; Waseda Institute of Social and Human Capital Studies (WISH), Tokyo, Japan
Haruko Noguchi: Faculty of School of Political Science and Economics, Tokyo, Japan; WISH, Tokyo, Japan
Yichen Shen: Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Kanagawa, Japan; WISH, Tokyo, Japan

No 2520, Working Papers from Waseda University, Faculty of Political Science and Economics

Abstract: The maternity ward closures are observing across many countries, yet little known about how the closures affect obstetrician behavior and delivery practices. The unique institutional setting in Japan, exclusion of natural delivery from public health insurance, creates a unique institutional setting for analyzing physician’s delivery practices. This study analyzes the effect of hospital-based maternity ward closures on cesarean section practice and health outcomes. Using the Survey of Medical Institutions and Vital Statistics and employing a staggered difference-in-differences, we show that clinics increased the rate of cesarean section regardless of risk-factors of cesarean delivery. Moreover, this result was driven by private clinics. We interpret this result as evidence of overuse of cesarean sections that was caused by physician’s profit-maximizing behavior. Our findings imply that the expansion of insurance coverage for delivery care can mitigate this unintended effect.

Keywords: Cesarean delivery; Physician-induced demand; Maternity ward closure (search for similar items in EconPapers)
JEL-codes: I13 I18 J1 (search for similar items in EconPapers)
Pages: 35 pages
Date: 2025-08
New Economics Papers: this item is included in nep-hea and nep-lab
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