Medical Malpractice Liability Exposure and OB/GYN Physician Delivery Decisions

• Published in: Health services research 2018-08, Vol.53 (4), p.2633-2650
• Main Authors: Durrance, Christine Piette, Hankins, Scott
• Format: Article
• Language: English
• Subjects: Analysis; Attorneys; Births; Cesarean; Cesarean section; Cesarean Section - legislation & jurisprudence; Cesarean Section - statistics & numerical data; Claims; Data collection; Data sources; Decision Making; defensive medicine; Female; Florida; Hospitalization; Hospitals; Humans; Insurance; Legal liability; Legal malpractice; Liability; Liability (Law); Liability, Legal; Litigation; Malpractice; Malpractice - legislation & jurisprudence; Medical malpractice; Medical malpractice insurance; Medical personnel; Medical societies; Multivariate analysis; Obstetrics; Panel data; physician liability; Physicians; Physicians - legislation & jurisprudence; Pregnancy; Professional malpractice; Vagina; Vaginal Birth after Cesarean - adverse effects; Vaginal Birth after Cesarean - legislation & jurisprudence; Vaginal Birth after Cesarean - statistics & numerical data; vaginal births after Cesarean; Workforce Training and Practice
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12813

Objective This study examines the effect of physician medical malpractice liability exposure on primary Cesarean and vaginal births after Cesarean (VBACs). Data Sources/Study Setting Secondary data on hospital births from Florida Hospital Inpatient File, physician characteristics from American Medical Association Physician Masterfile, and physician malpractice claim history from Florida Office of Insurance Regulation. Study Design Our study estimates the effects of physician malpractice liability exposure on Cesareans and VBACs using panel data and a multivariate, fixed effects model. Data Collection We merge three secondary data sources based on unique physician license numbers between 1994 and 2010. Principal Findings We find no evidence that the first malpractice claim affects primary Cesarean deliveries. We find, however, that the first malpractice claim decreases the likelihood of a VBAC (conditional on a prior Cesarean delivery) by 1.2–1.9 percentage points (approximately 10 percent relative to mean VBAC incidence). This finding is robust to focusing on obstetrics‐related malpractice claims, as well as to considering different malpractice claims (first report, first severe report, and first lawsuit). Conclusions Given the increase in both primary and repeat Cesarean deliveries, our results suggest that physician malpractice liability exposure is responsible for a relatively small share of the VBAC decrease.