Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities

Sofia Amaral-Garcia, Paola Bertoli, Veronica Grembi

Research output: Working paperResearch

Abstract

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.
Original languageEnglish
Place of PublicationRome
PublisherCEIS - Tor Vergata
Number of pages35
Publication statusPublished - Mar 2015
SeriesResearch Paper Series / CEIS Tor Vergata
Number4 (no. 342)
Volume13

Cite this

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, No. 4 (no. 342), Vol.. 13