Impact of Malpractice Claims on Outcomes, Access Final rept. (June 1, 2004-May 31, 2005)

摘要

This dissertation examines the economic response of individual physicians to malpractice claims. The first research objective is to understand whether malpractice claims influence delivery volumes, or adverse outcome rates. The second goal is to analyze whether physicians alter their Medicaid patient mix or C-section rate. The third objective is to analyze whether malpractice award levels raise the likelihood of physician exit. In this study, a unique and detailed panel data set links observations at the individual physician-year level in the state of Florida. The scope of analysis will be in obstetrics with inpatient deliveries associated with births from 1992-2000. Findings from this study will be used to examine changes in practice patterns and outcomes in response to malpractice pressure. The primary data sets used are the Florida Hospital Patient Discharge data set, and the Florida Medical Professional Liability Insurance Claims Files, for the period from 1992- 2000. Dependent variables include the number of birth-related deliveries, the rate of adverse outcomes, the C-section rate, the Medicaid patient mix, and the likelihood of physician exit. Explanatory variables include malpractice claims and ICD-9 codes for patient severity adjustment. Malpractice claims do have an impact on physician behavior by reducing delivery volumes. An incident occurrence is positively associated with the adverse outcome rate, and a rise in the C-section rate. Physicians with a very high malpractice claim award (i.e. $500,000 or more) have a much greater likelihood of exit.