Do tort reforms impact the incidence of birth by cesarean section? A reassessment

Investigations into the existence and impact of defensive medicine in obstetrics have produced mixed and often conflicting implications. The most widely-cited and accepted results in this literature find that less severe malpractice environments cause an increase in the use of cesarean section. This...

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Bibliographic Details
Published inInternational journal of health care finance and economics Vol. 17; no. 1; pp. 103 - 112
Main Authors Cano-Urbina, Javier, Montanera, Daniel
Format Journal Article
LanguageEnglish
Published New York Springer 01.03.2017
Springer US
Springer Nature B.V
Subjects
Birth
Births
Cesarean section
Cesarean Section - statistics & numerical data
Defensive Medicine - statistics & numerical data
Economic Policy
Female
Health Administration
Health Care Management
Health Economics
Humans
Incidence
Malpractice
Malpractice - legislation & jurisprudence
Medicine
Medicine & Public Health
Obstetric Labor Complications - epidemiology
Obstetrics
Pregnancy
Public Finance
Public Health
Research Design
SHORT PAPER
Socioeconomic Factors
United States
Vaginal Birth after Cesarean
United States > US
I18
Medical malpractice
Defensive medicine
K13
Obstetrics
H75
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Summary:Investigations into the existence and impact of defensive medicine in obstetrics have produced mixed and often conflicting implications. The most widely-cited and accepted results in this literature find that less severe malpractice environments cause an increase in the use of cesarean section. This has been interpreted as "offensive medicine"; taking advantage of lenient malpractice environments by providing unnecessary services in order to raise revenue. In this article we show that an assumption concerning births with an unknown method of delivery, which is not explicitly stated in the literature, is pivotal in obtaining these results. Using data on tort reforms and birth outcomes from 1989 to 2001 in 24 US states, we show that for the 98.4% of births with a confirmed method of delivery, the estimated effects of tort reform on C-section rates are insignificant. Therefore, without this assumption, there is little evidence to support an interpretation of offensive medicine.
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ISSN:2199-9023
2199-9031
DOI:10.1007/s10754-016-9202-8