Disentangling Sources of Variation in C-Section Rates

Stefanie Fischer, Shuhei Kaneko, Heather Royer and Corey White

No 34469, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: Cesarean section rates vary widely across U.S. counties, yet it remains unclear how much of this variation reflects demand-side factors (such as patient risk or preferences) versus supply-side factors (such as physician practices or hospital incentives). We develop a new empirical strategy to isolate the influence of supply-side forces. Exploiting hospital obstetric unit closures from 1989–2019 that reallocate some mothers to counties with different C-section rates, we find that a one–percentage-point increase in the delivery county’s rate raises a mother’s likelihood of a C-section by roughly one point. The results point to a dominant role for provider behavior and local practice norms in driving geographic variation in C-section use, the most common major surgery in the United States.

JEL-codes: I18 I38 J08 J13 J18 (search for similar items in EconPapers)
Date: 2025-11
New Economics Papers: this item is included in nep-dem, nep-hea and nep-lab
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