Women's Health

Obstetrician malpractice claims lead to small reduction in inpatient deliveries, but not C-section rates

A dramatic rise in malpractice insurance premiums has sparked concern among physicians and health policymakers that access to care may be limited by physicians who no longer practice certain types of procedures. In a study of whether the timing of malpractice claims or the size of awards had any impact on obstetrical practice patterns in Florida, Gilbert W. Gimm, Ph.D., of Mathematica Policy Research, found a small decrease (six fewer per year) in the number of inpatient deliveries performed by physicians 3 years after the closing of a malpractice claim. If the malpractice award was $250,000 or higher, physicians performed 14 fewer deliveries on average. Dr. Gimm did not find increased C-section rates or diminished access to obstetrical services.

Recent studies on the impact of malpractice pressure on physician supply have found small or no effects. Another indicator of diminished access would be if travel times for women undergoing high-risk deliveries increased. However, a Florida-based study found that travel times were not affected by tort reform. The author sought to extend these studies by providing evidence on whether practice patterns and delivery volume were affected by the timing of a claim or the size of an award. The somewhat greater reduction in delivery volume (11 percent vs. 5 percent) in response to higher awards suggests that tort reforms with damage caps at $250,000 would have some effect on limiting the reduction in average delivery volume.

During the study period (1992-2000), the average delivery volume of obstetrician-gynecologists (OB/GYNs) increased from 112 to 142 births, while deliveries by family practitioners declined from 80 to 41 births. The growth in the overall supply of physicians coupled with the increase in average volume of deliveries by OB/GYNs suggests that the small reduction in inpatient deliveries by OB/GYNs who had been sued was fully absorbed by other OB/GYNs. The findings were based on data on 1.2 million hospital deliveries in Florida during 1992-2000. The final sample included 1,772 physicians, almost all of whom were OB/GYNs. This study was supported by the Agency for Healthcare Research and Quality (HS14515).

See "The impact of malpractice liability claims on obstetrical practice patterns," by Dr. Gimm, in the February 2010 HSR: Health Services Research 45(1), pp. 195-211.

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