Using data about
births from the
perinatal information system (PIS) registered in Montevideo (
Uruguay), we estimated the
probability of having a Caesarian section delivery, controlled by
risk factors and the endogeneity of the choice of
hospital. In
public hospitals in Montevideo there is a fixed payment system, but in
private hospitals this
procedure has to be paid for separately. In the former, there is no effect on the doctor's
income if he performs a Caesarian, but in the latter there is a positive effect. Empirical evidence shows the
probability of a
Caesarean section increases with the age of the
woman, the presence of eclampsy, pre-eclampsy, previous
hypertension, previous
Caesarean sections,
multiple pregnancies and fetopelvic disproportion, and decreases for multiparous
women and
women in a
public hospital. In fact, the
probability of having a
Caesarean section in a private institution is almost two times higher than in a
public hospital (20% as against 39%). Focusing on
women without
risk factors, we found that the
probability a Caesarian in a
public hospital was 11%, but the
probability in a
private hospital was 25%. We conclude that the
remuneration system explains an important part of this difference.