Abstract
Investigations into the existence and impact of defensive medicine in obstetrics have produced mixed and often conflicting implications. The most widely-cited and accepted results in this literature find that less severe malpractice environments cause an increase in the use of cesarean section. This has been interpreted as “offensive medicine”; taking advantage of lenient malpractice environments by providing unnecessary services in order to raise revenue. In this article we show that an assumption concerning births with an unknown method of delivery, which is not explicitly stated in the literature, is pivotal in obtaining these results. Using data on tort reforms and birth outcomes from 1989 to 2001 in 24 US states, we show that for the 98.4% of births with a confirmed method of delivery, the estimated effects of tort reform on C-section rates are insignificant. Therefore, without this assumption, there is little evidence to support an interpretation of offensive medicine.
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Notes
The authors would like to thank Janet Currie and W. Bentley MacLeod for their assistance in conducting the replication of their study, as well as for their helpful suggestions and comments.
The average amounts of the noneconomic-damages caps and of the punitive-damages caps are excluded from the summary statistics because they are not included in the regressions. Matching CM’s sample means for these variables would require following their method for deflating and imputing the amounts, which was not attempted in this study.
The tort reform variables were generated according to the exact coding used in CM. The authors thank Janet Currie and W. Bentley MacLeod for making their code available.
Frakes (2012) also suggests the true effect is smaller than CM’s estimate.
Assuming that data was recorded correctly in all sample states during subsequent years, this specification should determine the impact of the institutional delay in data collection on CM’s parameter estimates. The results indicate that, besides the magnitude of coefficient estimates, the institutional delay does not appear to drive much of CM’s findings.
CM indicate that their results were robust to the systematic exclusion of large states, but based on the third column of Table 3, this does not hold for the replication sample.
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Cano-Urbina, J., Montanera, D. Do tort reforms impact the incidence of birth by cesarean section? A reassessment. Int J Health Econ Manag. 17, 103–112 (2017). https://doi.org/10.1007/s10754-016-9202-8
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DOI: https://doi.org/10.1007/s10754-016-9202-8