Most major health reform proposals include reform of medical malpractice. A major objective of the current medical malpractice system is to improve quality of care. The authors examine the effect of variations in the threat of medical malpractice, measured by claims frequency and payments per exposure year, on various indicators of birth outcomes, fetal deaths, low Apgar score, death within 5 days of birth, infant death, and death or permanent impairment at 5 years of age. Data came from 2 sources: a Survey of Obstetrical Care of 963 women in Florida in 1992 who delivered 5 years previously; and a fetal death and a linked birth-death file obtained from Florida Vital Statistics for 1987. Among the outcomes considered, only fetal deaths decreased in response to an increased threat of being sued, and this relationship was only obtained from one of the data sets. Overall, no systematic improvement in birth outcomes in response to an increased threat of medical malpractice litigation was obtained.

Hickson, Gerald B.; Clayton, Ellen Wright; Entman, Stephen S.; Miller, Cynthia S.; Githens, Penny B.; Whetten-Goldstein, Kathryn; Sloan, Frank A. Author Information

This book addresses a topic of great concern in the fields of medicine and medical economics. The cost of malpractice insurance to physicians has been increasing rapidly in recent years, and in some areas is not even available. The book describes and analyses, in a non-technical way, the workings of physicians' own liability insurance.

It is not currently known whether sufficiently precise data on a previous pregnancy, labor and delivery, and early infancy can be obtained retrospectively. We conducted a telephone survey in 1991 of women who delivered babies between 1984 and 1986 at two teaching hospitals in Nashville, Tennessee, to assess how well mothers recall information on factors predictive of an adverse birth outcome. The survey yielded 102 usable responses that were compared with hospital records for mothers and infants. Overall, 89 percent agreement was found between women's responses and their charts. Respondents were not reluctant to answer potentially sensitive questions, and their technical knowledge was typically better for their own health than about some prenatal diagnostic procedures and their infants' health. We found no difference in recall accuracy according to whether mothers experienced some adversity with the index pregnancy. Accurate perinatal information can generally be obtained with a recall period as high as four to six years.

Abstract What makes medical malpractice insurance tick? How can we explain the behavior of malpractice insurers? This chapter discusses the nature of the product of malprnctice insurance, the nature and behavior of insurance firms, and the structure and behavior of the market. We start by describing some relevant characteristics of the malpractice product, firms, and market. Some of these arc common to the property-liability insur¬ ance industry, of which malpractice insurers arc a part. Other features are more specific to the malpractice insurance line.

Abstract Third, what explains the diver ity of ownership fonns in the insurance industry? The most notable difference in the malpractice market of the late 1980s compared with the 1970s was the relative decline of national stock insurers and the rise of physician¬ sponsored, largely state-specific insurers. ls there evidence that particular physician firms conduct their business differently? Are some forms of insurer ownership rela¬ tively efficient in the provision of medical malpractice insurance’? Do physician firms fill a niche not occupied by the traditional for-profit insurer? Answers are important for assessing the desirability of tax and regulatory policies that distinguish among organi¬ zational types.

Abstract Rate making begins with claims data and ends with a market test. In between come actuarial science, business judgment, and regulation. How does the full process trans¬ late past claims experience into premium offered to physician insured to cover future losses? What factors most affect projections of losses and hence rates? To what extent do prospective investment earnings influence premiums? Is competition or regulation more important as a further influence on rates? Might they both contribute to insurance cycles in premiums and availability? This chapter explores such issues.

Subject Economics of Health Medical and Healthcare Law Epidemiology Collection: Oxford Scholarship Online

Abstract Perhaps the single most innammatory accusation raised against malpractice and other property-liability insurers is that they have made excessive profits at the expense of consumers. Such charges have frequently surfaced in times of stress-notably after requests for substantial premium increases or withdrawal of insurers from some geo¬ graphic areas or lines of coverage. Critics have insisted that crises of availability are trumped up by an industry seeking excessive profits and have often demanded inves¬ tigations, pressured regulators to reject price rises, and even voted rate rollbacb, as under California’s Proposition 103 in 1988. The belief in insurance “ripoffs” is wide¬ spread. but systematic, long-term evidence has been sparse. Policymakers and other interested observers need more.

Abstract Among insurers, it is an article of faith that theirs is a heavily regulated (and taxed) industry. And so it is, in many ways. Among consumer advocates, it is an article of faith that most regulations codify industry preferences and that most regulators barely scratch the surface of insurers’ behavior, so that much stronger regulation is needed. And so they do, in other ways. The practical result is an evolving mix of competition and regulation across different spheres of operation . and over time, as different influences wax and wane. An unusual feature of the malpractice marketplace is the recent rise to dominance of provider-sponsored insurers (Chapters I, 2). Along with self-insurance, this leading role for the insureds themselves creates a kind of private regulation in the interests of dominant professionab. Primary insurers must also answer to their reinsurers (Chapter 5), who have a strong interest in many aspects of primary insurers’ practices. Market competition and the duty to shareholders (especially in physician•’-ponsorcd com¬ panies) are also strong forces. To what extent regulatory versus other factors affect insurance practice is a major policy issue.

Abstract This book addresses a topic of great concern in the fields of medicine and medical economics. The cost of malpractice insurance to physicians has been increasing rapidly in recent years, and in some areas is not even available. The book describes and analyses, in a non-technical way, the workings of physicians’ own liability insurance.

Abstract Claims management and loss reserving can seem dry, technical, and inconsequential¬ matters best left to insurance clerks in green eyeshades. At least, so it may appear to outsiders. Certainly, underwriting and premium setting appear more linked to insur¬ ance crises, antitrust and regulatory decisions, and other matters with superficially more policy relevance. But before readers skip this chapter, they should note that claims reserving vita!ly affects rate making and the timing of profits, and that loss management is in fact critical to the short-run profits and long-nm survival of any insurance company. These activities are most complicated in a line where a long claims tail and an unstable social and legal environment interact, as in medical malpractice.