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Lawsuit activity, defensive medicine, and small area variation: the case of cesarean sections revisited

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  • BROWN, III, H. SHELTON

Abstract

This paper examines whether delivery practice patterns (Cesarean sections or vaginal) are influenced by lawsuits or whether the hypothesized relationship is confounded by small area variation. The analysis uses multilevel analysis to deal with hospital- and Dartmouth Hospital Referral Region-level variation. The model includes patient clinical variables, patient socio-economic status, and hospital characteristics as control variables. The secondary data sources include hospital discharges from the 2002 Texas Health Care Information Council as well as 1988–2001 Texas Department of Insurance Closed Claim File data. After extracting the variation in delivery practice between hospitals and between Dartmouth Hospital Referral Regions in a multilevel model, the effects of lawsuits on defensive medicine are reduced but are still significant.

Suggested Citation

  • Brown, Iii, H. Shelton, 2007. "Lawsuit activity, defensive medicine, and small area variation: the case of cesarean sections revisited," Health Economics, Policy and Law, Cambridge University Press, vol. 2(3), pages 285-296, July.
    • Handle: RePEc:cup:hecopl:v:2:y:2007:i:03:p:285-296_00
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    Cited by:

    1. Grytten, Jostein & Skau, Irene & Sørensen, Rune, 2017. "The impact of the mass media on obstetricians’ behavior in Norway," Health Policy, Elsevier, vol. 121(9), pages 986-993.
    2. He, Alex Jingwei, 2014. "The doctor–patient relationship, defensive medicine and overprescription in Chinese public hospitals: Evidence from a cross-sectional survey in Shenzhen city," Social Science & Medicine, Elsevier, vol. 123(C), pages 64-71.
    3. Grytten, Jostein & Skau, Irene & Sørensen, Rune, 2011. "Do expert patients get better treatment than others? Agency discrimination and statistical discrimination in obstetrics," Journal of Health Economics, Elsevier, vol. 30(1), pages 163-180, January.

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