Praveen Dhankhar¹, M. Mahmud Khan, PhD², and Ila M. Semenick Alam, PhD¹. (1) Department of Economics, Tulane University, 206 Tilton Hall, Tulane University, New Orleans, LA 70118, 5048626080, pdhankm@tulane.edu, (2) Health Systems Management, Tulane University, 1440 Canal Street, #1900, New Orleans, LA 70112

Medical malpractice lawsuits should reduce the incidence of medical errors, improve quality of care and enhance health outcomes of patients. Theoretical and empirical studies suggest that risk of malpractice lawsuits encourages physicians to practice “defensive medicine”, utilization of medical resources beyond its optimal level of use. It has also been suggested that the perceived threat of lawsuits encourages physicians to avoid certain high risk patients, the phenomenon of ‘negative defensive medicine’. The purpose of this study is to examine both these potential consequences of medical malpractice lawsuits on obstetric care interventions. The fear of malpractice lawsuits is considered one of the causes of increased C-section deliveries (defensive medicine) and if certain patient characteristics increases the risk, physicians may avoid providing care to this specific types of patients (negative defensive medicine). This paper intends to examine the following questions: Does the threat of malpractice lawsuits lead to defensive medicine? Does the risk of lawsuit affect physician behavior and health outcomes? What is the impact of malpractice lawsuit risk on health outcomes of the patients? To analyze these questions, National Practitioner Data Bank (NPDB) information was combined with the Nationwide Inpatient Sample data of Healthcare Cost and Utilization Project (HCUP) for 1995 and 1997. Logit models with fixed effects for State and time were used along with claim frequency and claim severity as measures of malpractice pressure in each of the States. The degree of malpractice lawsuit pressure increases the probability of C-section delivery, controlling for other C-section indicating medical conditions. The fear of lawsuits shows no significant impact on mortality and morbidity of the mother or the mortality of the newborn. However, the propensity and intensity of lawsuits reduced morbidity of newborns. African Americans and Hispanics show a higher probability of cesarean delivery compared to whites and low income groups experience higher probability of cesarean delivery. The empirical analysis suggests that malpractice pressure does lead to higher prevalence of C-section deliveries but it also leads to an improvement in the health of newborns without adversely affecting the health of mothers. Therefore, the threat of lawsuit increases the utilization of health care services. There is no conclusive indication in the literature that patients from low income families or from minority population groups are more likely to file malpractice lawsuits than others. Higher prevalence of C-sections among African Americans or women from poor areas does not necessarily support the idea of negative defensive medicine.

Learning Objectives:

• At the conclusion of this session, the participant in this session will be able to evaluate the effect of malpractice liability pressure on physician behavior and health outcomes.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.