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The Repeal of Noneconomic Damage Caps and Medical Malpractice Insurance Premiums

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  • Yuji Mizushima
  • Christopher Whaley
  • Hao Yu

Abstract

Noneconomic damage caps are controversial because they seek to balance uncertain benefits through reductions in physician precautionary costs, against uncertain harms to patient welfare. Opposing policy actions at the state‐level reflect this controversy as some states have enacted noneconomic damage caps over the past few decades while others repealed their caps. Our difference‐in‐differences analyses suggest that repeals increase premiums. These increases are larger after State Supreme Court decisions, affecting all cases in a state, compared with State Circuit Court decisions affecting only specific cases. Magnitudes differ by physician specialty, with larger effects observed in obstetrics/gynecology and general surgery, compared with internal medicine. Our estimates of these repeals are larger than estimates on enactments reported in the literature, suggesting a potential asymmetry between enacting and repealing damage caps.

Suggested Citation

  • Yuji Mizushima & Christopher Whaley & Hao Yu, 2025. "The Repeal of Noneconomic Damage Caps and Medical Malpractice Insurance Premiums," Health Economics, John Wiley & Sons, Ltd., vol. 34(12), pages 2223-2237, December.
    • Handle: RePEc:wly:hlthec:v:34:y:2025:i:12:p:2223-2237
    DOI: 10.1002/hec.70032
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    References listed on IDEAS

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    1. Bruno Ferman & Cristine Pinto, 2019. "Inference in Differences-in-Differences with Few Treated Groups and Heteroskedasticity," The Review of Economics and Statistics, MIT Press, vol. 101(3), pages 452-467, July.
    2. 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.
    3. Kessler, Daniel & McClellan, Mark, 2002. "Malpractice law and health care reform: optimal liability policy in an era of managed care," Journal of Public Economics, Elsevier, vol. 84(2), pages 175-197, May.
    4. Daniel Kahneman & Amos Tversky, 2013. "Prospect Theory: An Analysis of Decision Under Risk," World Scientific Book Chapters, in: Leonard C MacLean & William T Ziemba (ed.), HANDBOOK OF THE FUNDAMENTALS OF FINANCIAL DECISION MAKING Part I, chapter 6, pages 99-127, World Scientific Publishing Co. Pte. Ltd..
    5. Dubay, Lisa & Kaestner, Robert & Waidmann, Timothy, 2001. "Medical malpractice liability and its effect on prenatal care utilization and infant health," Journal of Health Economics, Elsevier, vol. 20(4), pages 591-611, July.
    6. Mushinski, David & Zahran, Sammy & Frazier, Aanston, 2022. "Physician behaviour, malpractice risk and defensive medicine: an investigation of cesarean deliveries," Health Economics, Policy and Law, Cambridge University Press, vol. 17(3), pages 247-265, July.
    7. A. Colin Cameron & Jonah B. Gelbach & Douglas L. Miller, 2008. "Bootstrap-Based Improvements for Inference with Clustered Errors," The Review of Economics and Statistics, MIT Press, vol. 90(3), pages 414-427, August.
    8. Avraham, Ronen & Schanzenbach, Max, 2015. "The impact of tort reform on intensity of treatment: Evidence from heart patients," Journal of Health Economics, Elsevier, vol. 39(C), pages 273-288.
    9. Bertoli, Paola & Grembi, Veronica, 2019. "Malpractice risk and medical treatment selection," Journal of Public Economics, Elsevier, vol. 174(C), pages 22-35.
    10. Alberto Abadie, 2021. "Using Synthetic Controls: Feasibility, Data Requirements, and Methodological Aspects," Journal of Economic Literature, American Economic Association, vol. 59(2), pages 391-425, June.
    11. Sebastian Galiani & Brian Quistorff, 2017. "The synth runner package: Utilities to automate synthetic control estimation using synth," Stata Journal, StataCorp LLC, vol. 17(4), pages 834-849, December.
    12. Galizzi, Matteo M. & Miraldo, Marisa & Stavropoulou, Charitini & van der Pol, Marjon, 2016. "Doctor–patient differences in risk and time preferences: A field experiment," Journal of Health Economics, Elsevier, vol. 50(C), pages 171-182.
    13. Abadie, Alberto & Diamond, Alexis & Hainmueller, Jens, 2010. "Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program," Journal of the American Statistical Association, American Statistical Association, vol. 105(490), pages 493-505.
    14. Alejandro Arrieta & Ariadna García‐Prado & Paula González & José Luis Pinto‐Prades, 2017. "Risk attitudes in medical decisions for others: An experimental approach," Health Economics, John Wiley & Sons, Ltd., vol. 26(S3), pages 97-113, December.
    15. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(1), pages 249-275.
    16. Alberto Abadie & Jérémy L’Hour, 2021. "A Penalized Synthetic Control Estimator for Disaggregated Data," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 116(536), pages 1817-1834, October.
    17. Patricia H. Born & J. Bradley Karl & W. Kip Viscusi, 2017. "The net effects of medical malpractice tort reform on health insurance losses: the Texas experience," Health Economics Review, Springer, vol. 7(1), pages 1-16, December.
    18. Janet Currie & W. Bentley MacLeod, 2008. "First Do No Harm? Tort Reform and Birth Outcomes," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 123(2), pages 795-830.
    19. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    20. Michael Frakes & Jonathan Gruber, 2019. "Defensive Medicine: Evidence from Military Immunity," American Economic Journal: Economic Policy, American Economic Association, vol. 11(3), pages 197-231, August.
    21. MacKinnon, James G. & Webb, Matthew D., 2020. "Randomization inference for difference-in-differences with few treated clusters," Journal of Econometrics, Elsevier, vol. 218(2), pages 435-450.
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