Too much care? private health care sector and surgical interventions during childbirth in India

Abstract

This paper evaluates the role of the private sector in performing one of the common surgical interventions, i.e. caesarean sections during childbirth in India. We use the latest round of National Family Health Survey to estimate the differential probability of C-section in private medical facilities relative to government facilities. We employ two estimation techniques, Household Fixed Effects and Coarsened Exact Matching, to reduce the extent of selection bias in the choice of delivery location. We also take advantage of a new question introduced in the survey which allows identification of planned C-sections which are more likely to be the result of either demand for C-section or unobservable (in the data) medical risks. We find that the probability of an unplanned C-section is 13.5-14 percentage points higher in the private sector. Given that some of the planned C-sections could be a result of supplier-induced demand, this is a very conservative estimate. Our results suggest that there were potentially 0.9 million preventable C-sections in the private sector in 2016. These results therefore call for a critical assessment of the role of private sector in healthcare in the context of inadequate public provision, expanding private provision and weak governance structures.