Do Physicians Respond to Liability Standards?

Abstract

In this paper, we explore the sensitivity in the clinical decisions of physicians to the standards of care expected of them under the law, drawing on the abandonment by states over time of rules holding physicians to standards determined by local customs and the contemporaneous adoption of national-standard rules. Using data on broad rates of surgical interventions at the county-by-year level from the Area Resource File, we find that local surgery rates converge towards national surgery rates upon the adoption of national-standard rules. Moreover, we find that these effects are more pronounced among rural counties. (JEL: I10, K13, K41)

The effect of malpractice law on physician supply: Evidence from negligence-standard reforms

“…These findings complement our prior research (Frakes, Frank and Seabury 2015), where we found that treatment utilization patterns are sensitive to the adoption of national-standard rules.…”

“…Collectively, the findings from the present paper and from Frakes, Frank and Seabury (2015) and Frakes (2013) raise a question regarding the mechanisms underlying the treatment intensity responses documented in these prior works. Was the convergence in practices documented in these studies likely attributable to given physicians modifying their practices in connection with altered clinical expectations-e.g., do given physicians practice more intensively when an initially low-intensity regions adopts a national standard rule that expects physicians to follow more intensive styles?…”

“…In some robustness checks, we include state-specific linear time trends, φst, which account for slowly-moving correlations between physician mix in a state and the adoption of a national-standard law. In our main approach to differentiating counties by initial practice intensity levels, we follow Frakes (2013) and Frakes, Frank and Seabury (2015) and focus separately on counties with initially above-and below-average treatment intensity rates-to this effect, HIc indicates that an initially high treatment-intensity county. 14 The term , ×…”

“…Including all counties in our specifications may compromise our ability to isolate physician recruitment and physician location decision mechanisms insofar as the lack of a hospital in the first place may leave little room for such mechanisms to operate. With this consideration in mind, we follow the same approach taken in Frakes, Frank and Seabury (2015) and estimate specifications that focus on those counties that on average over the sample period have at least some meaningful hospital presence, which we capture by having at least a mean of 50 hospital beds over the sample. By conditioning our analysis on some baseline level of inpatient facility supply, we may be able to identify a more continuous relationship between liability standards and the physician composition mix.…”

The impact of tort reform on defensive medicine, quality of care, and physician supply: A systematic review

“…Other studies have found that requiring physicians to follow national standards as opposed to local standards leads to standardization of clinical practices. 56,57 Recent approaches to liability reform aim to discourage defensive medicine while fostering process improvement both at the physician and at the system level. 'Alternative dispute resolu- also proposed reform ideas such as safe harbors for providers who adhere to clinical practice guidelines, a version of administrative 'health courts' and protection of apologies from use in malpractice litigation.…”