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The effect of medical malpractice liability on rate of referrals received by specialist physicians

Published online by Cambridge University Press:  26 March 2013

Xiao Xu ,
Stephen J. Spurr ,
Bin Nan  and
A. Mark Fendrick
Xiao Xu*
Affiliation:
Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
Stephen J. Spurr
Affiliation:
Professor, Department of Economics, Wayne State University, Detroit, MI, USA
Bin Nan
Affiliation:
Professor, Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
A. Mark Fendrick
Affiliation:
Professor, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
*
Correspondence to: Xiao Xu, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 310 Cedar Street, LSOG 205B, PO Box 208063 New Haven, CT 06520, USA. Email: xiao.xu@yale.edu
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Abstract

Using nationally representative data from the United States, this paper analyzed the effect of a state's medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state's malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state's medical malpractice environment on physicians’ referral behavior.

Type
Articles
Information
Health Economics, Policy and Law , Volume 8 , Issue 4 , October 2013 , pp. 453 - 475
Copyright
Copyright © Cambridge University Press 2013 

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