The impact of malpractice fears on cesarean section rates

Medical malpractice liability and its effect on prenatal care utilization and infant health.

Tracking career satisfaction and perceptions of quality among US obstetricians and gynecologists.

In recent years hospital uncompensated care has been declining in the seven states studied here: California, Florida, Washington, Connecticut, Maryland, New Jersey, and New York. We document these declines and compare trends in uncompensated care in safety-net and other hospitals between the early 1980s and the early to mid-1990s. We discuss state responses to deal with the declines in hospital uncompensated care and their likely impact on the observed trends.

State trends in hospital uncompensated care

Nonclinical Factors Affecting Women’s Access to Trial of Labor After Cesarean Delivery

Hospitals' bad debt and charity care increased by nearly 30% between 1987 and 1990. However, beginning in 1987, federal legislation expanded Medicaid eligibility to pregnant women and infants with family incomes up to 133% of the federal poverty level, and gave states the option to extend coverage up to 185% of poverty. These expansions likely reduced the need for free hospital care. Controlling for other factors associated with provision of uncompensated care, this analysis shows the Medicaid expansions reduced uncompensated care by roughly 5.4%. For hospitals with a significant commitment to maternity and infant care, the burdens of uncompensated care were 28.5% lower than they would have been without the expansions.

Medicaid expansions for pregnant women and infants: easing hospitals' uncompensated care burdens?

This study examined, in 1992, the variation in the level of malpractice premiums, and the incremental malpractice premium costs associated with the practice of obstetrics for family practitioners and obstetricians. On average, in 1992 obstetricians and family practitioners providing obstetric services paid malpractice premiums of roughly $44,000 and $16,000, respectively. The incremental increase in malpractice premium costs represented roughly 70% of the premium the physicians would have paid had they not provided obstetric services. These results suggest that for both family practitioners and obstetricians, there is a considerable premium penalty associated with providing obstetric services which may have implications for women's access to obstetric services. Moreover, the results make it clear that physicians practicing in different states, and different specialists within a state, may face very different malpractice premium costs.

Norton Sa

Papers

Medicaid expansions for pregnant women and infants: easing hospitals' uncompensated care burdens?

The malpractice premium costs of obstetrics.