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Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities

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  • Amaral-Garcia, S.
  • Bertoli, P.
  • Grembi, V.

Abstract

We provide an assessment of the introduction of experience rating for medical malpractice insurance using 2002-2009 inpatient discharge records data on deliveries from the Italian Region of Piedmont. Considering experience rating as an increase in medical malpractice pressure, we show that such increase decreased the incidence of cesarean sections between 7 and 11.6% with no consequences on a broadly defined measure of complications. Our identification strategy exploits the territorial peculiarities of Piedmont: its 33 hospitals are distributed across 16 Courts' districts, 10 of which use schedules of non economic damages to set compensations for personal injuries and 6 do not. We use this ex-ante policy conditions to distinguish treated from control and implement first a difference in difference analysis, the robustness of which we test through a basic difference in discontinuities specification. We show that our results are robust to the different methodologies, and they can be explained in terms of a reduction in the discretion over obstetric decisions ratherthan a change in the risk profile of the patients.

Suggested Citation

  • Amaral-Garcia, S. & Bertoli, P. & Grembi, V., 2014. "Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities," Health, Econometrics and Data Group (HEDG) Working Papers 14/23, HEDG, c/o Department of Economics, University of York.
    • Handle: RePEc:yor:hectdg:14/23
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    References listed on IDEAS

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    More about this item

    Keywords

    experience rating; medical liability insurance; difference-in-differences; difference-in-discontinuities; c-sections; schedules of damages compensation;
    All these keywords.

    JEL classification:

    • K13 - Law and Economics - - Basic Areas of Law - - - Tort Law and Product Liability; Forensic Economics
    • K32 - Law and Economics - - Other Substantive Areas of Law - - - Energy, Environmental, Health, and Safety Law
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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