Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities

Sofia Amaral-Garcia, Paola Bertoli, Veronica Grembi

Publikation: Working paperForskning

Resumé

We provide an assessment of the introduction of experience rating for medical malpractice insurance using 2002-2009 inpatient discharge records data on deliveries from the Italian Region of Piedmont. Considering experience rating as an increase in medical malpractice pressure, we show that such increase decreased the incidence of cesarean sections between 7 and 11.6% with no consequences on a broadly defined measure of complications. Our identification strategy exploits the territorial peculiarities of Piedmont: its 33 hospitals are distributed across 16 Courts' districts, 10 of which use schedules of non economic damages to set compensations for personal injuries and 6 do not. We use this ex-ante policy conditions to distinguish treated from control and implement first a difference in difference analysis, the robustness of which we test through a basic difference in discontinuities specification. We show that our results are robust to the different methodologies, and they can be explained in terms of a reduction in the discretion over obstetric decisions ratherthan a change in the risk profile of the patients.
OriginalsprogEngelsk
Udgivelses stedYork
UdgiverUniversity of York
Antal sider27
StatusUdgivet - 2014
NavnHEDG Working Paper
Nummer14/23
ISSN1751-1976

Emneord

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

Citer dette

Amaral-Garcia, S., Bertoli, P., & Grembi, V. (2014). Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities. York: University of York. HEDG Working Paper , Nr. 14/23
Amaral-Garcia, Sofia ; Bertoli, Paola ; Grembi, Veronica . / Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities. York : University of York, 2014. (HEDG Working Paper ; Nr. 14/23).
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abstract = "We provide an assessment of the introduction of experience rating for medical malpractice insurance using 2002-2009 inpatient discharge records data on deliveries from the Italian Region of Piedmont. Considering experience rating as an increase in medical malpractice pressure, we show that such increase decreased the incidence of cesarean sections between 7 and 11.6{\%} with no consequences on a broadly defined measure of complications. Our identification strategy exploits the territorial peculiarities of Piedmont: its 33 hospitals are distributed across 16 Courts' districts, 10 of which use schedules of non economic damages to set compensations for personal injuries and 6 do not. We use this ex-ante policy conditions to distinguish treated from control and implement first a difference in difference analysis, the robustness of which we test through a basic difference in discontinuities specification. We show that our results are robust to the different methodologies, and they can be explained in terms of a reduction in the discretion over obstetric decisions ratherthan a change in the risk profile of the patients.",
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Amaral-Garcia, S, Bertoli, P & Grembi, V 2014 'Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities' University of York, York.

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

York : University of York, 2014.

Publikation: Working paperForskning

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Amaral-Garcia S, Bertoli P, Grembi V. Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities. York: University of York. 2014.