IDEAS home Printed from https://ideas.repec.org/p/zbw/vfsc16/145645.html
   My bibliography  Save this paper

Do Doctors Prescribe Antibiotics Out of Fear of Malpractice?

Author

Listed:
  • Panthöfer, Sebastian

Abstract

Doctors in the U.S. (and elsewhere) prescribe too many antibiotics. According to recent estimates, between 25 and 50% of all antibiotics prescribed in U.S. ambulatory care are inappropriate (CDC 2013, Shapiro et al. 2014). At the same time, there exist large differences in antibiotic usage across U.S. states, with some states prescribing twice as many antibiotics as others (Hicks et al. 2013). The abuse of antibiotics has severe consequences. Most importantly, it promotes the growth of antibiotic resistance, which is one of the most pressing public health issues that many developed countries face today. At least two million people become infected with antibiotic-resistant bacteria in the U.S. every year, and more than 23,000 die as a direct consequence from these infections (CDC 2013). According to the Centers of Disease Control and Prevention (CDC), the best way to control antibiotic resistance is to decrease the inappropriate use of antibiotics. To achieve this goal, one must first identify the factors that lead to inappropriate prescriptions, which are still largely misunderstood. One candidate explanation for the excessive use of antibiotics in the U.S. compared to other developed countries is the medical malpractice system. Doctors practicing medicine in the U.S. face considerable legal pressure: more than 7% of all doctors are sued every given year, and the lifetime risk of being sued is north of 75% (Jena et al. 2011). In response to this liability pressure, doctors have been found to resort to defensive medicine, i.e., to administer diagnostic tests, treatments, or medications with expected benefits below cost to protect themselves against legal proceedings (Kessler and McClellan 1996). The frequent use of antibiotics may constitute a form of defensive medicine: doctors may feel inclined to prescribe an antibiotic against their own clinical judgement because the antibiotic presents a safeguard against serious bacterial infections, which may trigger a malpractice claim if left untreated. Anecdotal evidence and physician surveys support this theory. For instance, of the 669 physicians who participated in a survey in Pennsylvania, 33% reported that they frequently prescribe more medication than medically indicated in response to liability pressure, and an additional 36% reported that they occasionally prescribe medication to avoid potential litigation (Studdert et al. 2005). However, to date, no attempt has been made to examine the influence of liability pressure on antibiotic prescribing in actual clinical decisions. This paper is the first to systematically examine the relationship between liability pressure and antibiotic prescriptions. Using a simple theoretical model of physician prescribing behavior, I link the effect that a tort reform has on the number of antibiotics prescribed with the clinical appropriateness of these prescriptions. The model can be used to test for whether antibiotics constitute a form of defensive medicine. Using 19 years of data from the National Ambulatory Care Survey (NAMCS), a nationally representative sample of visits to office-based physicians in the U.S., I estimate the causal effect of liability pressure on antibiotic prescription rates with a difference-in-differences model that exploits the variation in tort law reforms across U.S. states. I allow for heterogenous responses to the malpractice environment across doctors and patients, e.g. based on the patient's type of health insurance. Throughout the analysis, I carefully consider the possibility of legislative endogeneity.

Suggested Citation

  • Panthöfer, Sebastian, 2016. "Do Doctors Prescribe Antibiotics Out of Fear of Malpractice?," VfS Annual Conference 2016 (Augsburg): Demographic Change 145645, Verein für Socialpolitik / German Economic Association.
  • Handle: RePEc:zbw:vfsc16:145645
    as

    Download full text from publisher

    To our knowledge, this item is not available for download. To find whether it is available, there are three options:
    1. Check below whether another version of this item is available online.
    2. Check on the provider's web page whether it is in fact available.
    3. Perform a search for a similarly titled item that would be available.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Daniel P. Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," NBER Working Papers 5466, National Bureau of Economic Research, Inc.
    2. Shurtz, Ity, 2013. "The impact of medical errors on physician behavior: Evidence from malpractice litigation," Journal of Health Economics, Elsevier, vol. 32(2), pages 331-340.
    3. 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.
    4. Ronen Avraham, 2007. "An Empirical Study of the Impact of Tort Reforms on Medical Malpractice Settlement Payments," The Journal of Legal Studies, University of Chicago Press, vol. 36(S2), pages 183-229, June.
    5. Danzon, Patricia M., 2000. "Liability for medical malpractice," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 26, pages 1339-1404, Elsevier.
    6. Ity Shurtz, 2014. "Malpractice Law, Physicians' Financial Incentives, and Medical Treatment: How Do They Interact?," Journal of Law and Economics, University of Chicago Press, vol. 57(1), pages 1-29.
    7. Kathryn Zeiler & Charles Silver & Bernard Black & David A. Hyman & William M. Sage, 2007. "Physicians' Insurance Limits and Malpractice Payments: Evidence from Texas Closed Claims, 1990-2003," The Journal of Legal Studies, University of Chicago Press, vol. 36(S2), pages 9-45, June.
    8. Kwon, Illoong & Jun, Daesung, 2015. "Information disclosure and peer effects in the use of antibiotics," Journal of Health Economics, Elsevier, vol. 42(C), pages 1-16.
    9. Daniel Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 353-390.
    10. Sofia Amaral-Garcia & Paola Bertoli & Veronica Grembi, 2015. "Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities in Italy," CERGE-EI Working Papers wp540, The Center for Economic Research and Graduate Education - Economics Institute, Prague.
    11. Andrew Friedson & Thomas Kniesner, 2012. "Losers and losers: Some demographics of medical malpractice tort reforms," Journal of Risk and Uncertainty, Springer, vol. 45(2), pages 115-133, October.
    12. Toshiaki Iizuka, 2007. "Experts' agency problems: evidence from the prescription drug market in Japan," RAND Journal of Economics, RAND Corporation, vol. 38(3), pages 844-862, September.
    13. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, Oxford University Press, vol. 119(1), pages 249-275.
    14. Janet Currie & W. Bentley MacLeod, 2008. "First Do No Harm? Tort Reform and Birth Outcomes," The Quarterly Journal of Economics, Oxford University Press, vol. 123(2), pages 795-830.
    15. Heckman, J.J. & Hotz, V.J., 1988. "Choosing Among Alternative Nonexperimental Methods For Estimating The Impact Of Social Programs: The Case Of Manpower Training," University of Chicago - Economics Research Center 88-12, Chicago - Economics Research Center.
    16. Sofia Amaral‐Garcia & Paola Bertoli & Veronica Grembi, 2015. "Does Experience Rating Improve Obstetric Practices? Evidence from Italy," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1050-1064, September.
    17. Matter, Ulrich & Stutzer, Alois, 2015. "Politico-economic determinants of tort reforms in medical malpractice," Working papers 2015/02, Faculty of Business and Economics - University of Basel.
    18. Fogelberg, Sara, 2013. "Effects of Competition between Healthcare Providers on Prescription of Antibiotics," Working Paper Series 949, Research Institute of Industrial Economics, revised 20 Nov 2014.
    19. Daniel Bennett & Che-Lun Hung & Tsai-Ling Lauderdale, 2015. "Health Care Competition and Antibiotic Use in Taiwan," Journal of Industrial Economics, Wiley Blackwell, vol. 63(2), pages 371-393, June.
    20. 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.
    21. Lundin, Douglas, 2000. "Moral hazard in physician prescription behavior," Journal of Health Economics, Elsevier, vol. 19(5), pages 639-662, September.
    22. David Dranove & Subramaniam Ramanarayanan & Yasutora Watanabe, 2012. "Delivering Bad News: Market Responses to Negligence," Journal of Law and Economics, University of Chicago Press, vol. 55(1), pages 1-25.
    23. Dubay, Lisa & Kaestner, Robert & Waidmann, Timothy, 1999. "The impact of malpractice fears on cesarean section rates," Journal of Health Economics, Elsevier, vol. 18(4), pages 491-522, August.
    24. Currie, Janet & Lin, Wanchuan & Meng, Juanjuan, 2014. "Addressing antibiotic abuse in China: An experimental audit study," Journal of Development Economics, Elsevier, vol. 110(C), pages 39-51.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Paola Bertoli & Veronica Grembi, 2017. "Medical Malpractice: How Legal Liability Affects Medical Decisions," CERGE-EI Working Papers wp600, The Center for Economic Research and Graduate Education - Economics Institute, Prague.
    2. Bertoli, Paola & Grembi, Veronica, 2019. "Malpractice risk and medical treatment selection," Journal of Public Economics, Elsevier, vol. 174(C), pages 22-35.
    3. Castro, Massimo Finocchiaro & Ferrara, Paolo Lorenzo & Guccio, Calogero & Lisi, Domenico, 2019. "Medical malpractice liability and physicians’ behavior: Experimental evidence," Journal of Economic Behavior & Organization, Elsevier, vol. 166(C), pages 646-666.
    4. Sofia Amaral-Garcia & Paola Bertoli & Veronica Grembi, 2015. "Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities in Italy," CEIS Research Paper 342, Tor Vergata University, CEIS, revised 08 May 2015.
    5. 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.
    6. Castro, M.F.; & Ferrara, P.; & Guccio, C.; & Lisi, D.;, 2018. "Medical Malpractice Liability and Physicians’ Behavior:Experimental Evidence," Health, Econometrics and Data Group (HEDG) Working Papers 18/11, HEDG, c/o Department of Economics, University of York.
    7. 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.
    8. Barili, Emilia & Bertoli, Paola & Grembi, Veronica, 2021. "Fee equalization and appropriate health care," Economics & Human Biology, Elsevier, vol. 41(C).
    9. Barili, E; & Bertoli, P; & Grembi, V;, 2020. "Title: Fees equalization and Appropriate Health Care," Health, Econometrics and Data Group (HEDG) Working Papers 20/09, HEDG, c/o Department of Economics, University of York.
    10. Cotet-Grecu, Anca, 2015. "The impact of non-economic damages caps on obstetrics: Incentives versus practice style," Economics & Human Biology, Elsevier, vol. 17(C), pages 29-41.
    11. Bertoli,P.; Grembi,V.;, 2017. "Exploring the nexus between certainty in injury compensation and treatment selection," Health, Econometrics and Data Group (HEDG) Working Papers 17/17, HEDG, c/o Department of Economics, University of York.
    12. Lakdawalla, Darius N. & Seabury, Seth A., 2012. "The welfare effects of medical malpractice liability," International Review of Law and Economics, Elsevier, vol. 32(4), pages 356-369.
    13. Daniel Carvell & Janet Currie & W. Bentley MacLeod, 2012. "Accidental death and the rule of joint and several liability," RAND Journal of Economics, RAND Corporation, vol. 43(1), pages 51-77, March.
    14. Angelo Antoci & Alessandro Fiori Maccioni & Paolo Russu, 2018. "Medical practice and malpractice litigation in an evolutionary context," Journal of Evolutionary Economics, Springer, vol. 28(4), pages 915-928, September.
    15. Sofia Amaral‐Garcia & Paola Bertoli & Veronica Grembi, 2015. "Does Experience Rating Improve Obstetric Practices? Evidence from Italy," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1050-1064, September.
    16. 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).
    17. 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.
    18. Scott Barkowski, 2017. "Does Regulation of Physicians Reduce Health Care Spending?," Southern Economic Journal, John Wiley & Sons, vol. 83(4), pages 1074-1097, April.
    19. Ellyson, Alice M. & Robertson, Justin C., 2019. "Can malpractice pressure compel a physician to relocate?," International Review of Law and Economics, Elsevier, vol. 57(C), pages 37-48.
    20. Daniel P. Kessler & Daniel L. Rubinfeld, 2004. "Empirical Study of the Civil Justice System," NBER Working Papers 10825, National Bureau of Economic Research, Inc.

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • K13 - Law and Economics - - Basic Areas of Law - - - Tort Law and Product Liability; Forensic Economics

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:zbw:vfsc16:145645. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: https://edirc.repec.org/data/vfsocea.html .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: ZBW - Leibniz Information Centre for Economics (email available below). General contact details of provider: https://edirc.repec.org/data/vfsocea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.