Exploring the influence of medical staffing and birth volume on observed-to-expected cesarean deliveries: a panel data analysis of integrated obstetric and gynecological departments in Germany

Arno Stöcker (), Holger Pfaff, Nadine Scholten and Ludwig Kuntz
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Arno Stöcker: University of Cologne
Holger Pfaff: University of Cologne
Nadine Scholten: University of Cologne
Ludwig Kuntz: University of Cologne

The European Journal of Health Economics, 2025, vol. 26, issue 6, No 6, 987-1022

Abstract: Abstract Introduction Cesarean deliveries account for approximately one-third of all births in Germany, prompting ongoing discussions on cesarean section rates and their connection to medical staffing and birth volume. In Germany, the majority of departments integrate obstetric and gynecological care within a single department. Methods The analysis utilized quality reports from German hospitals spanning 2015 to 2019. The outcome variable was the annual risk-adjusted cesarean section ratio—a metric comparing expected to observed cesarean sections. Explanatory variables included annual counts of physicians, midwives, and births. To account for case number-related staffing variations, full-time equivalent midwife and physician staff positions were normalized by the number of deliveries. Uni- and multivariate panel models were applied, complemented by multiple instrument variable analyses, including two-stage least square and generalized method of moments models. Results Incorporating data from 509 integrated obstetric departments and 2089 observations, representing 2,335,839 deliveries with 720,795 cesarean sections (over 60% of all inpatient births in Germany), multivariate model with fixed effects revealed a statistically significant positive association between the number of physicians per birth and the risk-adjusted cesarean section ratio (0.004, p = 0.004). Two-stage least square instrument variable analysis (0.020, p

Keywords: Longitudinal design; Obstetric care; Inpatient sector; Hospital; Organizational management; Medical staffing (search for similar items in EconPapers)
JEL-codes: C23 I10 N34 P46 (search for similar items in EconPapers)
Date: 2025
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DOI: 10.1007/s10198-024-01749-0

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