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Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities in Italy

Sofia Amaral-Garcia, Paola Bertoli and Veronica Grembi

CERGE-EI Working Papers from The Center for Economic Research and Graduate Education - Economics Institute, Prague

Abstract: Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in- differences and difference-in-discontinuities analyses. We find that the increase in medical malpractice pressure is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained by a reduction in the discretion of obstetric decision making rather than by patient cream skimming.

Keywords: experience rating; difference-in-discontinuities; scheduled damages; medical liability insurance; C-sections (search for similar items in EconPapers)
JEL-codes: K13 K32 I13 (search for similar items in EconPapers)
New Economics Papers: this item is included in nep-eur, nep-hea, nep-ias and nep-law
Date: 2015-05
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (12) Track citations by RSS feed

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