Defensive Medicine and Obstetric Practices

Frakes, Michael D.

doi:10.1111/j.1740-1461.2012.01259.x

Cited by 50 publications

(45 citation statements)

References 25 publications

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“…Currie and MacLeod () challenged this common idea that higher malpractice pressure induces obstetricians to perform excessive C‐sections, and they provided contrasting evidence. As already suggested by other studies (Sloan et al , ; Dubay et al , ; Frakes, ), they showed that higher malpractice pressure does not necessarily lead to a more frequent use of C‐sections. The finding of Currie and MacLeod () is consistent with a model of doctor behavior that depends on both patient conditions and the probability of committing an error with potential legal consequences.…”

Section: Introductionmentioning

confidence: 99%

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

2015

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Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7-11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream skimming.

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Section: Introductionmentioning

confidence: 99%

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

2015

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“…12,16,[27][28][29][30]32,[34][35][36]38,40,[42][43][44][45][46] Twelve studies evaluated the impact of tort reform on defensive medicine by assessing health care utilization 20,22,23,25,26,28,37,38,47,49,51,52 of which two (17 percent) used a difference-in-differences specification. 28,38 Thirteen studies studied quality of care 16,20,21,26,28,29,[33][34][35]37,41,48,54 of which five (38 percent) used a difference-in-differences specification. 16,28,29,34,35 Health care spending was evaluated by eight studies…”

Section: Study Characteristicsmentioning

confidence: 99%

“…28,38 Thirteen studies studied quality of care 16,20,21,26,28,29,[33][34][35]37,41,48,54 of which five (38 percent) used a difference-in-differences specification. 16,28,29,34,35 Health care spending was evaluated by eight studies 12,16,20,31,35,43,44,48 of which five (63 percent) used a difference-in-differences specification. 12,16,35,43,44 Thirteen studies evaluated the association of tort reform with physician supply 24,27,30,32,34,36,39,40,42,45,46,50,53 of which nine (69 percent) used a difference-in-differences specification.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…12,16,35,43,44 Thirteen studies evaluated the association of tort reform with physician supply 24,27,30,32,34,36,39,40,42,45,46,50,53 of which nine (69 percent) used a difference-in-differences specification. 12,16,[27][28][29][30]32,[34][35][36]38,40,[42][43][44][45][46] The study characteristics are summarized in Table 3 and presented in detail in Table S1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Nine studies evaluated the impact of caps on noneconomic damages on defensive medicine by assessing health care utilization. 20,22,25,26,28,38,47,51,52 Caps on noneconomic damages were associated with a significant reduction in health care utilization in five…”

Section: Defensive Medicine (Health Care Utilization)mentioning

confidence: 99%

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

Agarwal¹,

Gupta²,

Gupta

2019

Health Services Research

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Objective To evaluate the impact of tort reform on defensive medicine, quality of care, and physician supply. Data Sources Empirical, peer‐reviewed English‐language studies in the MEDLINE and HeinOnline databases that evaluated the association between tort reform and our study outcomes. Study Design We performed a systematic review in accordance with the PRISMA guidelines. Data Collection/Extraction Methods Title and abstract screening was followed by full‐text screening of relevant citations. We created evidence tables, grouped studies by outcome, and qualitatively compared the findings of included studies. We assigned a higher rating to study designs that controlled for unobservable sources of confounding. Principal Findings Thirty‐seven studies met screening criteria. Caps on damages, collateral‐source rule reform, and joint‐and‐several liability reform were the most common types of tort reform evaluated in the included studies. We found that caps on noneconomic damages were associated with a decrease in defensive medicine, increase in physician supply, and decrease in health care spending, but had no effect on quality of care. Other reform approaches did not have a clear or consistent impact on study outcomes. Conclusions We conclude that traditional tort reform methods may not be sufficient for health reform and policy makers should evaluate and incorporate newer approaches.

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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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Defensive Medicine and Obstetric Practices

Cited by 50 publications

References 25 publications

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

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

Malpractice Liability and Health Care Quality

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