Document Detail


Relationship between malpractice litigation pressure and rates of cesarean section and vaginal birth after cesarean section.
MedLine Citation:
PMID:  19169125     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Since the 1990s, nationwide rates of vaginal birth after cesarean section (VBAC) have decreased sharply and rates of cesarean section have increased sharply. Both trends are consistent with clinical behavior aimed at reducing obstetricians' exposure to malpractice litigation.
OBJECTIVE: To estimate the effects of malpractice pressure on rates of VBAC and cesarean section.
RESEARCH DESIGN, SUBJECTS, MEASURES: We used state-level longitudinal mixed-effects regression models to examine data from the Natality Detail File on births in the United States (1991-2003). Malpractice pressure was measured by liability insurance premiums and tort reforms. Outcome measures were rates of VBAC, cesarean section, and primary cesarean section.
RESULTS: Malpractice premiums were positively associated with rates of cesarean section (beta = 0.15, P = 0.02) and primary cesarean section (beta = 0.16, P = 0.009), and negatively associated with VBAC rates (beta = -0.35, P = 0.01). These estimates imply that a $10,000 decrease in premiums for obstetrician-gynecologists would be associated with an increase of 0.35 percentage points (1.45%) in the VBAC rate and decreases of 0.15 and 0.16 percentage points (0.7% and 1.18%) in the rates of cesarean section and primary cesarean section, respectively; this would correspond to approximately 1600 more VBACs, 6000 fewer cesarean sections, and 3600 fewer primary cesarean sections nationwide in 2003. Two types of tort reform-caps on noneconomic damages and pretrial screening panels-were associated with lower rates of cesarean section and higher rates of VBAC.
CONCLUSIONS: The liability environment influences choice of delivery method in obstetrics. The effects are not large, but reduced litigation pressure would likely lead to decreases in the total number cesarean sections and total delivery costs.
Authors:
Y Tony Yang; Michelle M Mello; S V Subramanian; David M Studdert
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical care     Volume:  47     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-26     Completed Date:  2009-02-02     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  234-42     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Cesarean Section / legislation & jurisprudence*,  utilization
Female
Humans
Infant, Newborn
Insurance, Liability / legislation & jurisprudence,  statistics & numerical data
Liability, Legal
Malpractice / legislation & jurisprudence*
Medicare / statistics & numerical data
Obstetric Labor Complications / mortality
Pregnancy
Risk Factors
United States
Utilization Review / statistics & numerical data
Vaginal Birth after Cesarean / legislation & jurisprudence*,  utilization
Grant Support
ID/Acronym/Agency:
1 K25 HL081275/HL/NHLBI NIH HHS; K25 HL081275/HL/NHLBI NIH HHS; K25 HL081275-01/HL/NHLBI NIH HHS
Comments/Corrections

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