NBER

David Silver

Department of Economics
Princeton University
124 Julis Romo Rabinowitz
Princeton, NJ 08544
Tel: 609/258-6917

E-Mail: EmailAddress: hidden: you can email any NBER-related person as first underscore last at nber dot org
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NBER Program Affiliations: HC
NBER Affiliation: Faculty Research Fellow
Institutional Affiliation: Princeton University

NBER Working Papers and Publications

June 2019The Health Impacts of Hospital Delivery Practices
with David Card, Alessandra Fenizia: w25986
Hospital treatment practices vary widely, often with little connection to the medical needs of patients. We assess the impact of these differences in the context of childbirth. We focus on low-risk first births, where cesarean delivery rates vary enormously across hospitals, and where policymakers have focused much of their attention in calls for reducing unnecessary c-sections. We find that proximity to hospitals with high c-section rates leads to more cesarean deliveries, fewer vaginal births after prolonged labor, and higher average Apgar scores. Infants whose mothers’ choice of a high c-section hospital is attributable to distance are more likely to visit the emergency department for a respiratory-related problem in the year after birth but are less likely to be readmitted to hospital....
April 2018The Health Effects of Cesarean Delivery for Low-Risk First Births
with David Card, Alessandra Fenizia: w24493
Cesarean delivery for low-risk pregnancies is generally associated with worse health outcomes for infants and mothers. The interpretation of this correlation, however, is confounded by potential selectivity in the choice of birth mode. We use birth records from California, merged with hospital and emergency department (ED) visits for infants and mothers in the year after birth, to study the causal health effects of cesarean delivery for low-risk first births. Building on McClellan, McNeil, and Newhouse (1994), we use the relative distance from a mother’s home to hospitals with high and low c-section rates as an instrument for c-section. We show that relative distance is a strong predictor of c-section but is orthogonal to many observed risk factors, including birth weight and indicators...

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