The Impact of Malpractice Liability Claims on Physician Outcomes and Practice Patterns
- Presenter:
Chair: Edward Norton; Discussant: Hua Wang Tue June 6, 2006 15:30-17:00 Room 309
ABSTRACT
Author: Gilbert W. Gimm, Ph.D. (ggimm@mathematica-mpr.com), Health Researcher, Mathematica Policy Research, Washington, DC.
Title: “The Impact of Malpractice Liability Claims on Physician Outcomes and Practice Patterns: Evidence from the State of Florida (1992-2000)”
Key Terms: malpractice claims, physician behavior, outcomes, quality
Objectives: Since the late 1960s, a dramatic rise in medical malpractice premiums has sparked both debate and concern among physicians and health policymakers. However, empirical evidence is limited to a few studies, which rely on market-level variation, so the impact of claims on the individual response of physicians is not well understood. This study examines whether malpractice claims have an impact on individual physician behavior, with respect to delivery volume, adverse outcome rates, and C-section rates. It also analyzes the factors that contribute to the likelihood of physician exit.
Methodology: This study uses a micro-level panel data set, which links inpatient deliveries in the state of Florida to malpractice claims from 1992-2000, with unique physician identifiers. The identification strategy for the impact on delivery volume is a fixed-effect OLS levels regression that controls for time-invariant, unobservable characteristics of individual physicians. Explanatory claim variables include whether the closing of a claim occurred in a specific year, as well as the award size and severity index measure associated with a malpractice claim. Other control variables include patient characteristics and medical risk factors. Finally, a binary logistic regression is used to estimate the likelihood of physician exit.
Results: Physicians perform 6-10 fewer inpatient deliveries per year in response to the closing of a malpractice claim, after controlling for fixed effects. However, malpractice claims do not appear to have a significant impact on the adverse outcome rate. Also, an incident occurrence is associated with a higher C-section rate among older physicians. Finally, physicians with a malpractice claim award of $500,000 or more have a significantly greater likelihood of exit from performing inpatient deliveries altogether. These empirical results suggest that malpractice claims do have a significant effect on individual physician practice patterns.
Disclosure Statement: This research study was funded by an AHRQ dissertation grant number 1-R36-HS014515-01.
