Does Experience Rating Improve Obstetric Practices? Evidence from Italy

Sofia Amaral-Garcia, Paola Bertoli, Veronica Grembi

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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
Volume24
Issue number9
Pages (from-to)1050-1064
Number of pages15
ISSN1057-9230
DOIs
Publication statusPublished - 2015

Cite this

Amaral-Garcia, Sofia ; Bertoli, Paola ; Grembi, Veronica . / Does Experience Rating Improve Obstetric Practices? Evidence from Italy. In: Health Economics. 2015 ; Vol. 24, No. 9. pp. 1050-1064.
@article{e7691781b780403498848dc129680344,
title = "Does Experience Rating Improve Obstetric Practices?: Evidence from Italy",
abstract = "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.",
keywords = "Experience rating, Medical liability insurance, Scheduled damages, C-sections",
author = "Sofia Amaral-Garcia and Paola Bertoli and Veronica Grembi",
year = "2015",
doi = "10.1002/hec.3210",
language = "English",
volume = "24",
pages = "1050--1064",
journal = "Health Economics",
issn = "1057-9230",
publisher = "Wiley",
number = "9",

}

Amaral-Garcia, S, Bertoli, P & Grembi, V 2015, 'Does Experience Rating Improve Obstetric Practices? Evidence from Italy', Health Economics, vol. 24, no. 9, pp. 1050-1064. https://doi.org/10.1002/hec.3210

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

In: Health Economics, Vol. 24, No. 9, 2015, p. 1050-1064.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Does Experience Rating Improve Obstetric Practices?

T2 - Evidence from Italy

AU - Amaral-Garcia, Sofia

AU - Bertoli, Paola

AU - Grembi, Veronica

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

KW - Experience rating

KW - Medical liability insurance

KW - Scheduled damages

KW - C-sections

UR - http://sfx-45cbs.hosted.exlibrisgroup.com/45cbs?url_ver=Z39.88-2004&url_ctx_fmt=info:ofi/fmt:kev:mtx:ctx&ctx_enc=info:ofi/enc:UTF-8&ctx_ver=Z39.88-2004&rfr_id=info:sid/sfxit.com:azlist&sfx.ignore_date_threshold=1&rft.object_id=954925596561

U2 - 10.1002/hec.3210

DO - 10.1002/hec.3210

M3 - Journal article

VL - 24

SP - 1050

EP - 1064

JO - Health Economics

JF - Health Economics

SN - 1057-9230

IS - 9

ER -