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The Impact of Malpractice Risk on the Use of Obstetrics Procedures

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  • Beomsoo Kim

Abstract

Recent malpractice premium hikes and federal tort reform proposals have focused attention on medical liability costs. One frequent justification for tort reform proposals is the potential impact of liability on defensive medicine. There is, however, scant and conflicting evidence on whether malpractice risk alters physician practices. In this paper, I examine whether malpractice risk alters the procedure choices of obstetricians, who face one of the highest rates of malpractice lawsuits among medical specialties. By focusing on obstetricians, I can observe the impact of malpractice risk on the use of procedures such as cesarean sections, prenatal care visits, diagnostic tests, and so on. Because the measured malpractice risk may signal something unobserved about physician quality or practice style, I use malpractice claims against doctors with specialties other than obstetrics and gynecology (ob-gyn) as an instrument for ob-gyn claims. I find that cesarean section rates and most other measures of physician behavior are not sensitive to medical malpractice risk. (c) 2007 by The University of Chicago. All rights reserved.

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  • Beomsoo Kim, 2007. "The Impact of Malpractice Risk on the Use of Obstetrics Procedures," The Journal of Legal Studies, University of Chicago Press, vol. 36(S2), pages 79-119, June.
    • Handle: RePEc:ucp:jlstud:v:36:y:2007:i:s2:p:s79-s119
    DOI: 10.1086/520069
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    1. Daniel P. Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," NBER Working Papers 5466, National Bureau of Economic Research, Inc.
    2. Jayanta Bhattacharya, 2005. "Specialty Selection and Lifetime Returns to Specialization Within Medicine," Journal of Human Resources, University of Wisconsin Press, vol. 40(1).
    3. Bassett, Ken L. & Iyer, Nitya & Kazanjian, Arminee, 2000. "Defensive medicine during hospital obstetrical care: a by-product of the technological age," Social Science & Medicine, Elsevier, vol. 51(4), pages 523-537, August.
    4. Jeremiah E. Hurley, 1991. "Physicians' Choices of Specialty, Location, and Mode: A Reexamination within an Interdependent Decision Framework," Journal of Human Resources, University of Wisconsin Press, vol. 26(1), pages 47-71.
    5. Daniel Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 353-390.
    6. Katherine Baicker & Amitabh Chandra, 2005. "The Effect of Malpractice Liability on the Delivery of Health Care," NBER Chapters, in: Frontiers in Health Policy Research, Volume 8, National Bureau of Economic Research, Inc.
    7. Dubay, Lisa & Kaestner, Robert & Waidmann, Timothy, 1999. "The impact of malpractice fears on cesarean section rates," Journal of Health Economics, Elsevier, vol. 18(4), pages 491-522, August.
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    Cited by:

    1. Andrew Friedson & Thomas Kniesner, 2012. "Losers and losers: Some demographics of medical malpractice tort reforms," Journal of Risk and Uncertainty, Springer, vol. 45(2), pages 115-133, October.
    2. Xin Zhao & Xiaoxue Li & Benno Torgler & Uwe Dulleck, 2021. "Patient violence, physicians treatment decisions, and patient welfare: Evidence from China," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1461-1479, June.
    3. Janet Currie & W. Bentley MacLeod, 2008. "First Do No Harm? Tort Reform and Birth Outcomes," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 123(2), pages 795-830.
    4. Paola Bertoli & Veronica Grembi, 2018. "Medical Malpractice: How Legal Liability Affects Medical Decisions," Contributions to Economic Analysis, in: Health Econometrics, volume 127, pages 235-261, Emerald Group Publishing Limited.
    5. Scott Barkowski, 2017. "Does Regulation of Physicians Reduce Health Care Spending?," Southern Economic Journal, John Wiley & Sons, vol. 83(4), pages 1074-1097, April.
    6. Stoddard Christiana & Stock Wendy A. & Hogenson Elise, 2016. "The Impact of Maternity Leave Laws on Cesarean Delivery," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 16(1), pages 321-364, January.
    7. Cotet-Grecu, Anca, 2015. "The impact of non-economic damages caps on obstetrics: Incentives versus practice style," Economics & Human Biology, Elsevier, vol. 17(C), pages 29-41.
    8. Beomsoo Kim, 2010. "Do Doctors Induce Demand?," Pacific Economic Review, Wiley Blackwell, vol. 15(4), pages 554-575, October.
    9. Chopard, Bertrand & Musy, Olivier, 2023. "Market for artificial intelligence in health care and compensation for medical errors," International Review of Law and Economics, Elsevier, vol. 75(C).
    10. Morita, Hatsuru, 2018. "Criminal prosecution and physician supply," International Review of Law and Economics, Elsevier, vol. 55(C), pages 1-11.
    11. Annalisa Scognamiglio, 2019. "Cesarean sections: Use or abuse?," CSEF Working Papers 534, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    12. Sloan, Frank A. & Shadle, John H., 2009. "Is there empirical evidence for "Defensive Medicine"? A reassessment," Journal of Health Economics, Elsevier, vol. 28(2), pages 481-491, March.
    13. Erin M. Johnson & M. Marit Rehavi, 2016. "Physicians Treating Physicians: Information and Incentives in Childbirth," American Economic Journal: Economic Policy, American Economic Association, vol. 8(1), pages 115-141, February.
    14. Ity Shurtz, 2014. "Malpractice Law, Physicians' Financial Incentives, and Medical Treatment: How Do They Interact?," Journal of Law and Economics, University of Chicago Press, vol. 57(1), pages 1-29.
    15. Toshiaki Iizuka, 2013. "Does Higher Malpractice Pressure Deter Medical Errors?," Journal of Law and Economics, University of Chicago Press, vol. 56(1), pages 161-188.
    16. Daniel P. Kessler, 2011. "Evaluating the Medical Malpractice System and Options for Reform," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 93-110, Spring.
    17. Javier Cano-Urbina & Daniel Montanera, 2017. "Do tort reforms impact the incidence of birth by cesarean section? A reassessment," International Journal of Health Economics and Management, Springer, vol. 17(1), pages 103-112, March.

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