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The Effects of Malpractice Non-Economic Damage Caps on the Supply of Physician Labor: Heterogeneity by Physician Age and Risk.

ABSTRACT: We explore the impact of malpractice caps on non-economic damages that were enacted between 2003 and 2006 on the supply of physician labor, separately for high-malpractice risk and low-malpractice risk physician specialty types, and separately by young and old physicians. We use physician data from the Area Resource File for 2000-2011 and malpractice policy data from the Database of State Tort Law Reforms. We study the impact of these caps using a reverse natural experiment, comparing physician supply in nine states enacting new caps to physician supply in ten states that had malpractice caps in place throughout the full time period. We use an event study to evaluate changes in physician labor compared to the prior year. We find evidence that non-economic damage caps increased the supply of high-risk physicians <35 years of age by 0.93 physicians per 100,000 people in the year after the caps were enacted. Non-economic damage caps were cumulatively associated with an increase of 2.1 high-risk physicians <35 years of age per 100,000 people. Stronger non-economic damage caps generally had a larger impact on physical supply.

SUBMITTER: Pesko MF

PROVIDER: S-EPMC5675024 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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The Effects of Malpractice Non-Economic Damage Caps on the Supply of Physician Labor: Heterogeneity by Physician Age and Risk.

Pesko Michael F MF Cea Meagan M Mendelsohn Jayme J Bishop Tara F TF

International review of law and economics 20170321

We explore the impact of malpractice caps on non-economic damages that were enacted between 2003 and 2006 on the supply of physician labor, separately for high-malpractice risk and low-malpractice risk physician specialty types, and separately by young and old physicians. We use physician data from the Area Resource File for 2000-2011 and malpractice policy data from the Database of State Tort Law Reforms. We study the impact of these caps using a reverse natural experiment, comparing physician ...[more]

PMID: 29129949

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Project description:BackgroundThe progress of green credit in China is accelerating, but its development is uneven and insufficient in different regions. And whether the issuance of green credit can effectively promote the improvement of the environment and economy is not well understood.ObjectivePrevious research has found that green credit promotes economic growth through improvement of the industrial structure and green technological innovation. However, these studies have not considered the positive externality of environmental improvement even though environmental improvement and economic growth are requirements of the sustainable development concept.MethodsWe use the chain-mediated model to estimate the impact of green credit issuance on the economic growth of different provinces since the large-scale implementation of green credit in China with data from 2008 to 2016.Results and conclusionThis paper shows that the issuance of green credit can improve labor supply rather than labor productivity through the improvement of air quality to achieve regional economic growth. Such a chain-mediated path is different from the economic growth caused by industrial structural adjustment and green technology innovation. At the national level, every 1% increase in green credit issuance relative to industrial loans will increase the per capita gross domestic product (GDP) by approximately 4.6 yuan, or 0.012%, through air quality and labor supply, accounting for 2.875% of the total effect. Heterogeneity analysis indicates that due to regional industrial structure differences and diminishing marginal effects, the impact of green credit is stronger in the western region than in the eastern and central regions. For every 1% increase in the proportion of green credit issuance relative to industrial loans, the per capita GDP growth achieved through the chain-mediated path is approximately 30.17 yuan in the western region, approximately 6.6 times greater than that at the national level. Within a 95% confidence interval of 5000 bootstrap samples, this path is found to be true, and the chain-mediated effect accounts for approximately 12.96% of the total indirect effect.LimitationsThe limitation of this paper is the measurement of green credit. Although green credit has a large volume, it remains underdeveloped, and there is a lack of perfect indicators. Most existing studies have adopted only alternative or reverse indicators to measure the issuance of green credit. For example, this paper takes the interest expenditure of six high-energy-consuming enterprises as the reverse indicator, which may to a certain extent lead to the overestimation of the issuance of green credit and its impact on the environment and economy. Future research can accurately explore the performance of green credit on the basis of its mature development.

Project description:Study questionIs a higher use of resources by physicians associated with a reduced risk of malpractice claims?MethodsUsing data on nearly all admissions to acute care hospitals in Florida during 2000-09 linked to malpractice history of the attending physician, this study investigated whether physicians in seven specialties with higher average hospital charges in a year were less likely to face an allegation of malpractice in the following year, adjusting for patient characteristics, comorbidities, and diagnosis. To provide clinical context, the study focused on obstetrics, where the choice of caesarean deliveries are suggested to be influenced by defensive medicine, and whether obstetricians with higher adjusted caesarean rates in a year had fewer alleged malpractice incidents the following year.Study answer and limitationsThe data included 24,637 physicians, 154,725 physician years, and 18,352,391 hospital admissions; 4342 malpractice claims were made against physicians (2.8% per physician year). Across specialties, greater average spending by physicians was associated with reduced risk of incurring a malpractice claim. For example, among internists, the probability of experiencing an alleged malpractice incident in the following year ranged from 1.5% (95% confidence interval 1.2% to 1.7%) in the bottom spending fifth ($19,725 (£12,800; €17,400) per hospital admission) to 0.3% (0.2% to 0.5%) in the top fifth ($39,379 per hospital admission). In six of the specialties, a greater use of resources was associated with statistically significantly lower subsequent rates of alleged malpractice incidents. A principal limitation of this study is that information on illness severity was lacking. It is also uncertain whether higher spending is defensively motivated.What this study addsWithin specialty and after adjustment for patient characteristics, higher resource use by physicians is associated with fewer malpractice claims.Funding, competing interests, data sharingThis study was supported by the Office of the Director, National Institutes of Health (grant 1DP5OD017897-01 to ABJ) and National Institute of Aging (R37 AG036791 to JB). The authors have no competing interests or additional data to share.

Dataset Information

The Effects of Malpractice Non-Economic Damage Caps on the Supply of Physician Labor: Heterogeneity by Physician Age and Risk.

Publications

The Effects of Malpractice Non-Economic Damage Caps on the Supply of Physician Labor: Heterogeneity by Physician Age and Risk.

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