International Journal of Technology Assessment in Health Care

General Essays

Econometric Analysis of Variation in Cesarean Section Rates: A Cross-sectional Study of 59 Obstetrical Departments in Sweden

Ingemar Eckerlunda1 and Ulf-G Gerdthama2

a1 Stockholm School of Economics and The National Board of Health and Welfare

a2 Stockholm School of Economics


The objective of this study was to explain the variation in cesarean section rates among hospitals (obstetrical departments) in Sweden, and to discuss its potential economic consequences. Using data from The Swedish Medical Birth Registry 1991, we made a cross-sectional study of the cesarean section rate at the departmental level. We identified some 20 determinants, demand-related as well as supply-related. A general model including all these regressors was specified. After reducing this model, we were able to explain about one-quarter of the variation. We conclude that the large variation in cesarean section rates indicates inefficiency, due mainly to overutilization, but perhaps also underutilization. It is difficult to calculate the economic consequences or the welfare loss to society. We estimated an additional cost for unnecessary cesarean sections of 13—16 million Swedish crowns (SEK) per year.