My wife and I are due with our first in a short weeks, so naturally, this paper by econ job market candidate, Jessica Kiser, caught my eye.
Here's her abstract:
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Home births in the US have increased twofold since the early 2000s, yet little is known about the policies that have driven the increase. Moreover, this increase in births outside of hospitals prompts concerns for maternal and infant health. In this paper, I use natality data from 1989 to 2021 to estimate relative changes in the prevalence of home birth and subsequent health outcomes before and after a change in access to provider choice. Staggered difference-indifferences estimates indicate a 20–30 percent increase in home births when states increase provider choice through non-nursing midwifery licensing. I find the change in access is most salient for college-educated mothers, low-risk pregnancies, and mothers who pay out of pocket. I find little evidence of an effect on measures of infant health or maternal health.
Expansion of healthcare choice among prospective mothers benefited those mothers (because they could choose from a larger array of choices), saved money for the healthcare system, and didn't worsen healthcare outcomes for either mother or child. Win, win, win.
As Kiser writes:
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Specifically, increasing access to midwives and home birth results in around 3,700 additional home births per year without substantial negative health effects, translating to healthcare savings of 32 million dollars.
She concludes:
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This increase in home births does not correspond to a significant negative impact on infant health, aside from a possible increase in the occurrences of neonatal seizures, an extremely rare outcome. These results suggest that increasing access to non-traditional medical professionals like non-nurse midwives can improve the welfare of mothers by increasing their choices and be substantially cost-saving for society by reducing the total cost of birth.
Note: The policy shift she examines is not toward total laissez-faire, as it involves state licensure of non-nursing midwives. However, it's still a step in the direction of freer markets relative to what prevailed before, since midwives were precluded from assisting in these sorts of home births.
All in all, a great paper from someone who appears to be a very talented applied microeconomist. Hire her!
