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

Abstract

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.

Defensive medicine in Italy a nationwide survey

“…These results are consistent with those in the literature [2,4,5,7,16]. Surprisingly, only a small number of physicians stated that they prescribe more medications than medically indicated [4].…”

“…We believe this measurement issue is the major limitation of our study and indeed all studies investigating DM. We also recognise that other factors may affect DM rates, such as the enormous variation in the medical malpractice environment, and in the healthcare and welfare systems and legal institutions across countries [16]. This could also limit the generalisability of our findings.…”

“…In the United States, 93% of physicians reported practising DM in a hospital, and 78% of hospital doctors in the United Kingdom and 60% in Israel practised DM in a hospital [2,4,7]. The percentage of doctors practising DM is higher for some specialties, including, obstetrics and gynaecology (97%), gastroenterology (94-98%), neurosurgery (75-83%), and orthopaedics and traumatology (96%) [5,8,9,10,11,12,13,14,15,16,17].…”

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

“…Xu and colleagues showed that noneconomic damages caps of $250 000 were associated with a 32 percent lower likelihood of specialist referrals. There was no association with caps at higher amounts . Yang et al found that rates of vaginal birth after C‐section were significantly higher (8.0 percent) and C‐section rates were significantly lower (1.5 percent) with caps on noneconomic damages.…”

“…Seventeen studies (46 percent) used a difference-in-differences specification that controlled for unobservable confounders. 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.…”