Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities in Italy

Sofia Amaral-Garcia, Paola Bertoli, Veronica Grembi

Research output: Working paperResearchpeer-review


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 identied by the introduction of experience-rated malpractice liability insurance. Our identication 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.
Original languageEnglish
Place of PublicationPrag
Number of pages47
ISBN (Print)9788073433451, 9788073443375
Publication statusPublished - 2015
SeriesWorking Paper Series

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