THE BLOG

Does Malpractice Alter Obstetric Practice?

04/03/2010 05:12 am ET | Updated May 25, 2011
  • D. Brad Wright Assistant Professor in the Department of Health Management and Policy at the University of Iowa

Dr. Gilbert Gimm asks this question in a study appearing in the most recent issue of Health Services Research. The paper is based on results from Dr. Gimm's dissertation work, and his findings are noteworthy. Okay, let me back up. Why look at the link between malpractice and obstetric practice? Well, you've probably heard the argument that higher malpractice premiums have the effect of pushing physicians into lower-risk (and therefore lower-premium) specialties, or in some cases out of active practice altogether. There may be some truth to that, but it's obviously not the case that the nation is suddenly completely devoid of doctors. To the extent that it is true, obstetrics is a good place to look for a relationship, because delivering babies is a high risk thing to do.

In fact, some ways (e.g., natural childbirth) are actually higher risk than other ways (e.g., C-Section) because they are fraught with more potential complications. So, to avoid possible complications and ensuing litigation, obstetricians might increase the volume of C-Sections, for example. Alternatively, they may just deliver fewer babies. After all, if each delivery comes with an inherent risk, then the cumulative risk of an adverse event increases with the number of babies you bring into the world. Deliver enough babies, in fact, and the cumulative probability of you encountering an adverse event will approach 1.

Gimm does a lot of fancy econometric "stuff" with the data obtained from the State of Florida to conclude the following: Obstetricians aren't doing more C-Sections in the wake of a lawsuit. In some cases, however, obstetricians are delivering fewer babies after getting sued. Specifically, this effect was seen across the board three years after a lawsuit, with obstetricians delivering on average 6 fewer infants. Of note, if the lawsuit resulted in a large award ($250,000 or more), the obstetricians delivered on average 14 fewer infants.

The bottom line here? The threat of malpractice liability doesn't appear to have any impact on the practice of obstetrics, though it does tend to diminish caseloads ever so slightly, and that relationship appears to be related to the size of the award. So, there may be some slight justification for capping damages in malpractice cases, but we shouldn't expect such tort reform to dramatically overhaul the practice of medicine in this country--meaning, in turn, that it won't do much to control health care costs or improve quality, either.

Subscribe to Wright on Health to see what else I have to say during the week. You can also contact me here.