Kurzfassung

As health care costs continue to rise, policy makers seek ways to cut down on medical costs without harming health outcomes. One example for such a policy is to let (less costly) nurses take over tasks from (more costly) doctors. In The Netherlands, low-risk births are supervised by midwives, without any doctor being present. If this does not increase health risks, this might be an option that is worth considering for other countries as well.
We use data from the Netherlands Perinatal Registry...As health care costs continue to rise, policy makers seek ways to cut down on medical costs without harming health outcomes. One example for such a policy is to let (less costly) nurses take over tasks from (more costly) doctors. In The Netherlands, low-risk births are supervised by midwives, without any doctor being present. If this does not increase health risks, this might be an option that is worth considering for other countries as well.
We use data from the Netherlands Perinatal Registry (PRN), which contains detailed records of 99% of all births in The Netherlands between 2000 and 2008. The main issue in studying the effect of midwife vs. obstetrician/gynecologist (obs/gyn) supervised deliveries is that in the Dutch system, the former supervise all low-risk deliveries, whereas the latter supervise all high-risk deliveries. Naturally, newborns’ health outcomes between those are not comparable.
Therefore, we utilize a natural experiment: if a delivery occurs after 36 weeks and 6 days or earlier, it is considered high-risk. From 37 weeks and 0 days on, it is considered low-risk. Hence, very similar deliveries end up being supervised by different professionals due to a difference in gestational length of only 1 day. We exploit this regression discontinuity to investigate how going from obs/gyn supervised deliveries to midwife supervised deliveries affects newborns’ health.
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