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Defensive Medicine and Obstetric Practices

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  • Michael Frakes

Abstract

Using data on physician behavior from the 1979–2005 National Hospital Discharge Surveys (NHDS), I estimate the relationship between malpractice pressure, as identified by the adoption of noneconomic damage caps and related tort reforms, and certain decisions faced by obstetricians during the delivery of a child. The NHDS data, supplemented with restricted geographic identifiers, provides inpatient discharge records from a broad enough span of states and covering a long enough period of time to allow for a defensive medicine analysis that draws on an extensive set of variations in relevant tort laws. Contrary to the conventional wisdom, I find no evidence to support the claim that malpractice pressure induces physicians to perform a substantially greater number of cesarean sections. Extending this analysis to certain additional measures, however, I do find some evidence consistent with positive defensive behavior among obstetricians. For instance, I estimate that the adoption of a noneconomic damage cap is associated with a reduction in the utilization of episiotomies during vaginal deliveries, without a corresponding change in observed neonatal outcomes.

Suggested Citation

  • Michael Frakes, 2012. "Defensive Medicine and Obstetric Practices," Journal of Empirical Legal Studies, John Wiley & Sons, vol. 9(3), pages 457-481, September.
    • Handle: RePEc:wly:empleg:v:9:y:2012:i:3:p:457-481
    DOI: 10.1111/j.1740-1461.2012.01259.x
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    References listed on IDEAS

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    1. Daniel P. Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," NBER Working Papers 5466, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Hao Yu & Olesya Baker, 2022. "Do noneconomic damage caps reduce medical malpractice insurance premiums? Evidence from North Carolina," Risk Management and Insurance Review, American Risk and Insurance Association, vol. 25(2), pages 201-218, June.
    2. Sebastian Panthöfer, 2022. "Do doctors prescribe antibiotics out of fear of malpractice?," Journal of Empirical Legal Studies, John Wiley & Sons, vol. 19(2), pages 340-381, June.
    3. Barili, Emilia & Bertoli, Paola & Grembi, Veronica, 2021. "Fee equalization and appropriate health care," Economics & Human Biology, Elsevier, vol. 41(C).
    4. Klick, Jonathan & MacDonald, John, 2020. "Deterrence and liability for intentional torts," International Review of Law and Economics, Elsevier, vol. 63(C).
    5. de Elejalde, Ramiro & Giolito, Eugenio, 2021. "A demand-smoothing incentive for cesarean deliveries," Journal of Health Economics, Elsevier, vol. 75(C).
    6. Panthöfer, Sebastian, 2016. "Tort Reform and the Length of Physician Office Visits," UC3M Working papers. Economics 23861, Universidad Carlos III de Madrid. Departamento de Economía.
    7. Elissa P. Gentry & Benjamin J. McMichael, 2020. "Responses to Liability Immunization: Evidence from Medical Devices," Journal of Empirical Legal Studies, John Wiley & Sons, vol. 17(4), pages 789-819, December.
    8. Christoph Engel, 2013. "Behavioral Law and Economics: Empirical Methods," Discussion Paper Series of the Max Planck Institute for Research on Collective Goods 2013_01, Max Planck Institute for Research on Collective Goods.
    9. Frakes, Michael & Jena, Anupam B., 2016. "Does medical malpractice law improve health care quality?," Journal of Public Economics, Elsevier, vol. 143(C), pages 142-158.
    10. Philip DeCicca & Maripier Isabelle & Natalie Malak, 2024. "How do physicians respond to new medical research?," Health Economics, John Wiley & Sons, Ltd., vol. 33(10), pages 2206-2228, October.
    11. Zabinski, Zenon & Black, Bernard S., 2022. "The deterrent effect of tort law: Evidence from medical malpractice reform," Journal of Health Economics, Elsevier, vol. 84(C).
    12. Eric Helland & Anupam B. Jena & Dan P. Ly & Seth A. Seabury, 2016. "Self-insuring against Liability Risk: Evidence from Physician Home Values in States with Unlimited Homestead Exemptions," NBER Working Papers 22031, National Bureau of Economic Research, Inc.
    13. Brian K. Chen & Chun‐Yuh Yang, 2014. "Increased Perception of Malpractice Liability and the Practice of Defensive Medicine," Journal of Empirical Legal Studies, John Wiley & Sons, vol. 11(3), pages 446-476, September.
    14. Roth, Louise Marie, 2023. "Defensive versus evidence-based medical technology: Liability risk and electronic fetal monitoring in low-risk births," Social Science & Medicine, Elsevier, vol. 317(C).
    15. Morita, Hatsuru, 2018. "Criminal prosecution and physician supply," International Review of Law and Economics, Elsevier, vol. 55(C), pages 1-11.
    16. Javier Cano-Urbina & Daniel Montanera, 2017. "Do tort reforms impact the incidence of birth by cesarean section? A reassessment," International Journal of Health Economics and Management, Springer, vol. 17(1), pages 103-112, March.
    17. Malak, Natalie & Yang, Y. Tony, 2019. "A re-examination of the effects of tort reforms on obstetrical procedures and health outcomes," Economics Letters, Elsevier, vol. 184(C).
    18. Helland, Eric & Seabury, Seth A., 2015. "Tort reform and physician labor supply: A review of the evidence," International Review of Law and Economics, Elsevier, vol. 42(C), pages 192-202.
    19. Michael Frakes & Jonathan Gruber, 2020. "Defensive Medicine and Obstetric Practices: Evidence from the Military Health System," Journal of Empirical Legal Studies, John Wiley & Sons, vol. 17(1), pages 4-37, March.

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