dc.contributor.author | FACCHINI PALMA, Gabriel Alejandro | |
dc.date.accessioned | 2017-10-06T11:43:16Z | |
dc.date.available | 2017-10-06T11:43:16Z | |
dc.date.issued | 2017 | |
dc.identifier.citation | Florence : European University Institute, 2017 | en |
dc.identifier.uri | https://hdl.handle.net/1814/48244 | |
dc.description | Defence date: 02 October 2017 | en |
dc.description | Examining Board: Prof. Andrea Ichino, EUI, Supervisor Prof. Jérôme Adda, EUI and Bocconi University Prof. Joseph Doyle, MIT Sloan School of Management Prof. Libertad González, Universitat Pompeu Fabra | en |
dc.description.abstract | This aims at better understanding the drivers behind the volume-outcome rela- tionship found in many studies in the medical and health-economics literature. In the first chapter I investigate the relationship between workload and choice of treatment. Using detailed microdata on childbirth, I exploit a quasi-random assignment of patients attempting to have a natural delivery to different ratios of patients-to-midwives and compare their likelihood of changing delivery method. I find that women who face a ratio higher than 1.33 are 34% more likely to give birth by cesarean section (C-sections). This effect is larger for patients who were already admitted with a higher risk of C-section, since provision of proper and timely care matters more for these patients. Because C-sections are faster than vaginal deliveries, the medical team may find it appealing to do more C-sections when time constrained. Using civil status as a proxy for bargaining power -assuming single women are on average more likely to be alone-, I find that only single patients are subjected to unnecessary surgery. The second chapter documents the existence of `learning-by-doing' effects in physicians' performance. More specifically, I test whether cesarean-section surgeons who have performed more procedures in the recent-past observe an improvement in performance. By using data from the Italian health care system, where patients are not allowed to choose a physician, I eliminate concerns regarding possible bias from selective referral -a problem in previous studies. Using four years of birth certificates data from one large hospital I find that, for emergent cases, performing one additional procedure reduces the likelihood of neonatal intensive care unit admission by nearly 1.2 percentage points (5.5%) and of being born with a low Apgar Score by about 1.1 percentage points (10%), all else equal. | en |
dc.description.tableofcontents | -- 1 Low staffing in the maternity ward : keep calm and call the surgeon
-- 2 Forgetting-by-not-doing : the case of surgeons and cesarean sections | en |
dc.format.mimetype | application/pdf | en |
dc.language.iso | en | en |
dc.publisher | European University Institute | en |
dc.relation.ispartofseries | EUI | en |
dc.relation.ispartofseries | ECO | en |
dc.relation.ispartofseries | PhD Thesis | en |
dc.rights | info:eu-repo/semantics/openAccess | en |
dc.subject.lcsh | Medical economics | |
dc.subject.lcsh | Medical care, Cost of | |
dc.title | Essays in health economics | en |
dc.type | Thesis | en |
dc.identifier.doi | 10.2870/027466 | |
eui.subscribe.skip | true | |