Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities

Sofia Amaral-Garcia, Paola Bertoli, Veronica Grembi

Publikation: Working paperForskning

Resumé

Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. 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 and difference-in-discontinuities analyses. 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% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained by a reduction in the discretion of obstetric decision making rather than by patient cream skimming.Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. 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 and difference-in-discontinuities analyses. 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% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained by a reduction in the discretion of obstetric decision making rather than by patient cream skimming.
OriginalsprogEngelsk
Udgivelses stedRome
UdgiverCEIS - Tor Vergata
Antal sider35
StatusUdgivet - mar. 2015
NavnResearch Paper Series / CEIS Tor Vergata
Nummer4 (no. 342)
Vol/bind13

Emneord

  • Experience rating
  • Medical liability insurance
  • Difference-in-differences
  • Difference-in-Discontinuities
  • C-sections
  • Schedules damages

Citer dette

Amaral-Garcia, S., Bertoli, P., & Grembi, V. (2015). Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities. Rome: CEIS - Tor Vergata. Research Paper Series / CEIS Tor Vergata, Nr. 4 (no. 342), Bind. 13
Amaral-Garcia, Sofia ; Bertoli, Paola ; Grembi, Veronica . / Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities. Rome : CEIS - Tor Vergata, 2015. (Research Paper Series / CEIS Tor Vergata; Nr. 4 (no. 342), Bind 13).
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Amaral-Garcia, S, Bertoli, P & Grembi, V 2015 'Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities' CEIS - Tor Vergata, Rome.

Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities. / Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica .

Rome : CEIS - Tor Vergata, 2015.

Publikation: Working paperForskning

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Amaral-Garcia S, Bertoli P, Grembi V. Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities. Rome: CEIS - Tor Vergata. 2015 mar.