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Defensive Medicine and Obstetric Practices

Authors

  • Michael Frakes

    Corresponding author
    1. Assistant Professor of Law, Director of Law and Economics Program, Cornell Law School, 314 Myron Taylor Hall, Ithaca, NY 14853
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  • I am grateful to Amy Finkelstein and Jon Gruber for their guidance and advice and to Joe Doyle, Seth Seabury, and seminar participants at the Conference on Empirical Legal Studies, the American Law and Economics Association Annual Meeting, and the Harvard Law School Empirical Legal Studies Seminar for providing helpful comments. I am also grateful to the staff at the Research Data Center at the National Center for Health Statistics for their help with the National Hospital Discharge Survey files and to Ronen Avraham for graciously providing data on state tort laws. Funding from the National Institute on Aging, Grant Number T32-AG00186, is gratefully acknowledged.

Assistant Professor of Law, Director of Law and Economics Program, Cornell Law School, 314 Myron Taylor Hall, Ithaca, NY 14853; email: mdf96@cornell.edu.

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.

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