Damage Caps and Defensive Medicine: Reexamination with Patient‐Level Data

Moghtaderi, Ali; Farmer, Steven A.; Black, Bernard S.

doi:10.1111/jels.12208

Cited by 13 publications

(5 citation statements)

References 35 publications

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“…27,38 Of the 15 studies that reported no significant associations between liability measures and mortality in the deterrence direction, 9 used tort reforms as the measure of liability risk and 6 used claim frequency, average payment per paid claim, jury awards, or other measures (Table 3). These studies were also diverse in the patient populations studied, ranging from narrowly defined disease groups (eg, patients who had bladder cancer, 17 patients who underwent cranial neurosurgery 33 ) to wide patient populations (eg, all Medicare patients 18,44 ). Two of the 3 studies that found limited evidence of deterrence used tort reforms as the measure of liability risk.…”

Section: Evidence Concerning Patient Mortalitymentioning

confidence: 99%

Malpractice Liability and Health Care Quality

Frakes

Blumenkranz

Studdert

2020

JAMA

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IMPORTANCEThe tort liability system is intended to serve 3 functions: compensate patients who sustain injury from negligence, provide corrective justice, and deter negligence. Deterrence, in theory, occurs because clinicians know that they may experience adverse consequences if they negligently injure patients. OBJECTIVE To review empirical findings regarding the association between malpractice liability risk (ie, the extent to which clinicians face the threat of being sued and having to pay damages) and health care quality and safety.DATA SOURCES AND STUDY SELECTION Systematic search of multiple databases for studies published between January 1, 1990, and November 25, 2019, examining the relationship between malpractice liability risk measures and health outcomes or structural and process indicators of health care quality.DATA EXTRACTION AND SYNTHESIS Information on the exposure and outcome measures, results, and acknowledged limitations was extracted by 2 reviewers. Meta-analytic pooling was not possible due to variations in study designs; therefore, studies were summarized descriptively and assessed qualitatively. MAIN OUTCOMES AND MEASURESAssociations between malpractice risk measures and health care quality and safety outcomes. Exposure measures included physicians' malpractice insurance premiums, state tort reforms, frequency of paid claims, average claim payment, physicians' claims history, total malpractice payments, jury awards, the presence of an immunity from malpractice liability, the Centers for Medicare & Medicaid Services' Medicare malpractice geographic practice cost index, and composite measures combining these measures. Outcome measures included patient mortality; hospital readmissions, avoidable admissions, and prolonged length of stay; receipt of cancer screening; Agency for Healthcare Research and Quality patient safety indicators and other measures of adverse events; measures of hospital and nursing home quality; and patient satisfaction.RESULTS Thirty-seven studies were included; 28 examined hospital care only and 16 focused on obstetrical care. Among obstetrical care studies, 9 found no significant association between liability risk and outcomes (such as Apgar score and birth injuries) and 7 found limited evidence for an association. Among 20 studies of patient mortality in nonobstetrical care settings, 15 found no evidence of an association with liability risk and 5 found limited evidence. Among 7 studies that examined hospital readmissions and avoidable initial hospitalizations, none found evidence of an association between liability risk and outcomes. Among 12 studies of other measures (eg, patient safety indicators, process-of-care quality measures, patient satisfaction), 7 found no association between liability risk and these outcomes and 5 identified significant associations in some analyses. CONCLUSIONS AND RELEVANCEIn this systematic review, most studies found no association between measures of malpractice liability risk and health care quality and outcomes. Although gaps in the ev...

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Section: Evidence Concerning Patient Mortalitymentioning

confidence: 99%

Malpractice Liability and Health Care Quality

Frakes

Blumenkranz

Studdert

2020

JAMA

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“…A range of other studies, however, have failed to find evidence of any change in health-care utilization or spending in connection with variations in medical liability pressure. Included in this latter set of studies is Sloan and Shadle (2009), the Congressional Budget Office (2004), Paik et al (2017), and Moghtaderi et al (2017) (in each case drawing on damages caps and related reforms).…”

Section: Iia Defensive Medicine Background and Literature Reviewmentioning

confidence: 99%

Defensive Medicine and Obstetric Practices: Evidence from the Military Health System

Frakes¹,

Gruber²

2020

J Empirical Legal Studies

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We estimate the extent of defensive medicine by physicians during labor and delivery, drawing on a novel and significant source of variation in liability pressure. In particular, we embrace the no‐liability counterfactual made possible by the structure of liability rules in the Military Heath System. Active‐duty patients seeking treatment from military facilities cannot sue for harms resulting from negligent care, while protections are provided to dependents treated at military facilities and to all patients—active‐duty or not—who receive care from civilian facilities. Drawing on this variation and addressing endogeneity in the choice of treatment location by estimating mother fixed effects specifications and by exploiting exogenous shocks to care location choices stemming from base‐hospital closures, we find suggestive evidence that liability immunity increases cesarean utilization and treatment intensity during childbirth, with no measurable negative effect on patient outcomes.

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“…(6) The study includes data from Europe. *USA,11 12 14 76–145 New Zealand,74 75 146 147 China,148–150 Japan,151 152 Iran,153 Israel,154–160 Sudan,161 Canada,162 163 Australia,164 165 South Africa,166 Singapore,167 India,168 Hong Kong,169 Brazil170 and one study from both USA, Canada and South Africa 73…”

Section: Resultsmentioning

confidence: 99%

How defensive medicine is defined in European medical literature: a systematic review

et al. 2022

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ObjectivesDefensive medicine has originally been defined as motivated by fear of malpractice litigation. However, the term is frequently used in Europe where most countries have a no-fault malpractice system. The objectives of this systematic review were to explore the definition of the term ‘defensive medicine’ in European original medical literature and to identify the motives stated therein.DesignSystematic review.Data sourcesPubMed, Embase and Cochrane, 3 February 2020, with an updated search on 6 March 2021.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we reviewed all European original peer-reviewed studies fully or partially investigating ‘defensive medicine’.ResultsWe identified a total of 50 studies. First, we divided these into two categories: the first category consisting of studies defining defensive medicine by using a narrow definition and the second category comprising studies in which defensive medicine was defined using a broad definition. In 23 of the studies(46%), defensive medicine was defined narrowly as: health professionals’ deviation from sound medical practice motivated by a wish to reduce exposure to malpractice litigation. In 27 studies (54%), a broad definition was applied adding … or other self-protective motives. These self-protective motives, different from fear of malpractice litigation, were grouped into four categories: fear of patient dissatisfaction, fear of overlooking a severe diagnosis, fear of negative publicity and unconscious defensive medicine. Studies applying the narrow and broad definitions of defensive medicine did not differ regarding publication year, country, medical specialty, research quality or number of citations.ConclusionsIn European research, the narrow definition of defensive medicine as exclusively motivated by fear of litigation is often broadened to include other self-protective motives. In order to compare results pertaining to defensive medicine across countries, future studies are recommended to specify whether they are using the narrow or broad definition of defensive medicine.PROSPERO registration numberCRD42020167215.

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Damage Caps and Defensive Medicine: Reexamination with Patient‐Level Data

Cited by 13 publications

References 35 publications

Malpractice Liability and Health Care Quality

Malpractice Liability and Health Care Quality

Defensive Medicine and Obstetric Practices: Evidence from the Military Health System

How defensive medicine is defined in European medical literature: a systematic review

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