Does Tort Law Improve the Health of Newborns, or Miscarry? A Longitudinal Analysis of the Effect of Liability Pressure on Birth Outcomes


  • Subramanian was supported by the National Institutes of Health Career Development Award (NHLBI 1 HL081275). Studdert was supported in part by a Federation Fellowship from the Australian Research Council. The funding organizations had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the article for submission. The authors thank Drs. Roxane Gardner, Tom McElrath, and Martin November, of Brigham and Women's Hospital for their advice and input regarding obstetric practice.

Y. Tony Yang, George Mason University, MS: 1J3, 4400 University Dr., Fairfax, VA 22030; email: Yang is Assistant Professor of Health Policy and Law at George Mason University; Studdert is Professor and Federation Fellow, Faculty of Law and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne; Subramanian is Professor of Population Health and Geography, Department of Society, Human Development, and Health, Harvard School of Public Health; Mello is Professor of Law and Public Health, Department of Health Policy and Management, Harvard School of Public Health.


Previous research has identified an association between malpractice liability risk levels in a state and greater use of cesarean sections in obstetrical care. However, it is unclear whether such practice changes are associated with better birth outcomes. Using a mixed-effects model, we investigate the impact of malpractice risk, as measured by malpractice insurance premiums and various state tort reforms, on four adverse birth outcomes. We use a longitudinal research design to examine millions of individual births from 51 jurisdictions over 12 years (1991–2002). We find that the odds of adverse birth outcomes are not associated with premium levels or tort reforms. Our results suggest that rather than having a socially desirable deterrent effect on substandard care, liability pressure may produce a level of precaution taking in obstetrics that is higher than socially optimal. By the same token, the results also suggest that the adoption of liability-limiting reforms is unlikely to have an adverse impact on outcomes.