Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Xiao Xu, PhD¹, Kristine Siefert, PhD, MPH², Jody Lori, MS, CNM³, Peter Jacobson, JD, MPH⁴, Iana Gueorguieva⁵, and Scott B. Ransom, DO, MBA, MPH¹. (1) Department of Obstetrics and Gynecology, University of Michigan, L4000 Women's Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, 734-930-5614, xiaox@med.umich.edu, (2) School of Social Work, University of Michigan, 2846 SSWB, 1080 S. University, Ann Arbor, MI 48109, (3) School of Nursing, University of Michigan, 400 N. Ingalls Bldg., Room 3320, Ann Arbor, MI 48109, (4) Department of Health Management and Policy, School of Public Health, University of Michigan, M3515 SPH II, Ann Arbor, MI 48109, (5) College of Lit, Science & Arts, University of Michigan, 3061 Turnberry Lane, Ann Arbor, MI 48108

Timely and adequate access to obstetrical care plays a critical role in improving birth outcomes. However, the current medical liability crisis, including increasing malpractice litigation risk and high medical liability insurance premiums, has compelled some obstetrical providers to reduce or cease their obstetrical practice and restrict the amount of high-risk services they provide. If this happens disproportionately in underserved communities and areas with high incidence of high-risk pregnancies, it may significantly aggravate disparities in pregnancy outcomes. This study sought to examine the impact of rising medical liability pressure among obstetrical providers on disparities in patients' access to care, with particular attention to areas with special demand (e.g., areas with high incidence of high-risk pregnancies and adverse birth outcomes). We used stratified random sampling to select a sample of 2,000 Michigan physicians who may provide obstetrical care, including 1,200 family medicine/general medicine physicians and 800 obstetrician-gynecologists. In addition, 272 certified nurse-midwives practicing in the state of Michigan were also included in the survey. Two survey modes (mail survey and web-based survey) and repeated follow-ups were used to improve response rate (expected response rate = 60%). Statistical tests and multivariate regression analyses were performed to assess the current medical liability burden borne by obstetrical providers in Michigan and its implications for patient access to care and patient safety. Findings from this study will help inform the current debate of medical liability reform, and help reduce disparities in patient access to obstetrical care and birth outcomes.

Learning Objectives:

• Understand the current medical liability climate in the U.S.
• Recognize the potential contribution of medical liability pressure to racial/ethnic disparities in birth outcomes.
• Describe the potential impact of obstetrical providers' medical liability burden on patients' access to care in a large Midwestern state.

Keywords: Access to Care, Health Disparities

Presenting author's disclosure statement:

Not Answered