# Staff Resources in Public and Private Hospitals and Their Implication for Medical Practice: A French Study of Caesareans

## TL;DR

This study found that staffing levels in French public and private hospitals affect caesarean rates differently due to varying incentives.

## Contribution

The novel contribution is identifying how staffing ratios influence caesarean decisions differently in public versus private hospitals.

## Key findings

- Higher staff ratios of obstetricians and midwives in public hospitals correlate with lower planned caesarean rates.
- In private hospitals, higher obstetrician ratios correlate with higher planned caesarean rates.
- Staff incentives and hospital sector characteristics significantly influence medical practices like caesareans.

## Abstract

This study aimed to investigate the effect of hospital staffing resources on medical practice in public versus private hospitals. We used exhaustive delivery data from a French district of 11 hospitals over an 11-year period, from 2008 to 2018, including 168,120 observations. We performed multilevel logistic regression models with hospital fixed or random effects, while controlling for factors known to influence obstetric practice. We found that hospital staff ratios of obstetricians and that of midwives affected caesarean rates, but with different effects depending on the hospital sector. In public hospitals, the higher the ratio of obstetricians and that of midwives, the lower the probability of planned caesareans. In private hospitals, the higher the ratio of obstetricians, the greater the probability of planned caesareans. Indeed, in public hospitals, obstetricians and midwives, both salaried employees, do not have financial or organizational incentives to perform more caesareans. In private hospitals, obstetricians, who are independent doctors, may have such incentives. Our results underline the importance of having an adequate supply of health professionals in healthcare facilities to ensure appropriate care, with specific regard to the different characteristics of the public and private sectors.