A Longitudinal Analysis of the Impact of Liability Pressure on the Supply of Obstetrician‐Gynecologists

Yang, Y. Tony; Studdert, David M.; Subramanian, S. V.; Mello, Michelle M.

doi:10.1111/j.1740-1461.2007.00117.x

Cited by 27 publications

(25 citation statements)

References 8 publications

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“…Malpractice insurance premiums for general surgeons and obstetrician-gynecologists were calculated using the MLM’s annual survey data via a two-stage weighting approach (Yang et al , 2008). 3 Severity of malpractice claims and malpractice insurance premiums were adjusted to 2007 U.S. dollars (U.S.…”

Section: Methodsmentioning

confidence: 99%

The effect of medical malpractice liability on rate of referrals received by specialist physicians

Spurr

Nan

et al. 2013

HEPL

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Using nationally representative data from the U.S., this paper analyzed the effect of a state’s medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the U.S. during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state’s malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums, and an indicator for whether the state had a cap on noneconomic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on noneconomic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state’s medical malpractice environment on physicians’ referral behavior.

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Section: Methodsmentioning

confidence: 99%

The effect of medical malpractice liability on rate of referrals received by specialist physicians

Spurr

Nan

et al. 2013

HEPL

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“…We model damages caps using 4 dummy variables (1 punitive damages cap and 3 levels of noneconomic damages cap). Because tort reforms tend not to affect the malpractice climate instantaneously, 33 we lag each tort-reform variable by 1 year from the date of its implementation. If a tort reform was subsequently held unconstitutional, its value is set to zero beginning in the year after the holding.…”

Section: Methodsmentioning

confidence: 99%

Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section

Yang¹,

Mello²,

Subramanian³

et al. 2009

Medical Care

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190

145

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Background Since the 1990s, nationwide rates of vaginal birth after cesarean section (VBAC) have decreased sharply and rates of cesarean section have increased sharply. Both trends are consistent with clinical behavior aimed at reducing obstetricians’ exposure to malpractice litigation. Objective To estimate the effects of malpractice pressure on rates of VBAC and cesarean section. Research Design, Subjects, Measures We used state-level longitudinal mixed-effects regression models to examine data from the Natality Detail File on births in the United States (1991–2003). Malpractice pressure was measured by liability insurance premiums and tort reforms. Outcome measures were rates of VBAC, cesarean section, and primary cesarean section. Results Malpractice premiums were positively associated with rates of cesarean section (β = 0.15, P = 0.02) and primary cesarean section (β = 0.16, P = 0.009), and negatively associated with VBAC rates (β = −0.35, P = 0.01). These estimates imply that a $10,000 decrease in premiums for obstetrician-gynecologists would be associated with an increase of 0.35 percentage points (1.45%) in the VBAC rate and decreases of 0.15 and 0.16 percentage points (0.7% and 1.18%) in the rates of cesarean section and primary cesarean section, respectively; this would correspond to approximately 1600 more VBACs, 6000 fewer cesarean sections, and 3600 fewer primary cesarean sections nationwide in 2003. Two types of tort reform—caps on noneconomic damages and pretrial screening panels—were associated with lower rates of cesarean section and higher rates of VBAC. Conclusions The liability environment influences choice of delivery method in obstetrics. The effects are not large, but reduced litigation pressure would likely lead to decreases in the total number cesarean sections and total delivery costs.

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“…[8][9][10][11][12][13] Other studies have found such relationships to be complex, weak, or nonexistent.…”

Section: Background On Defensive Medicinementioning

confidence: 99%

Low Costs Of Defensive Medicine, Small Savings From Tort Reform

Thomas

Ziller²,

Thayer³

2010

Health Affairs

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In this paper we present the costs of defensive medicine in thirty-five clinical specialties to determine whether malpractice liability reforms would greatly reduce health care costs. Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.

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A Longitudinal Analysis of the Impact of Liability Pressure on the Supply of Obstetrician‐Gynecologists

Cited by 27 publications

References 8 publications

The effect of medical malpractice liability on rate of referrals received by specialist physicians

The effect of medical malpractice liability on rate of referrals received by specialist physicians

Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section

Low Costs Of Defensive Medicine, Small Savings From Tort Reform

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