Does Experience Rating Improve Obstetric Practices? Evidence from Italy

Sofia Amaral-Garcia, Paola Bertoli, Veronica Grembi

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Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. 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 analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. 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 (7–11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream skimming.
Original languageEnglish
JournalHealth Economics
Issue number9
Pages (from-to)1050-1064
Number of pages15
Publication statusPublished - 2015

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