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Liability, insurance and defensive medicine: new evidence

Author

Listed:
  • Paul Fenn

    (Nottingham University Business School)

  • Alastair Gray

    (Health Economics Research Centre, University of Oxford)

  • Neil Rickman

    (University of Surrey & CEPR)

Abstract

For the first time, we test for effects of liability on hospital care using measures of current perceptions of litigation risk at hospital level; in particular, the risk-sharing arrangements agreed between hospitals and their insurers. GMM and ML estimators are used to allow for possible endogeneity of risksharing arrangements. Our findings are consistent with the exercise of liabilityinduced discretion by hospitals, especially regarding use of costly diagnostic imaging. Hospitals facing higher expected litigation costs also use these tests more frequently, after controlling for activity levels, casemix and treatment outcome; the latter indicating that defensive medicine may be present. We also find evidence of fewer new claims against these hospitals, given adverse events, which may indicate the increased use of claims management processes by hospital managers concerned at the expected cost of litigation.

Suggested Citation

  • Paul Fenn & Alastair Gray & Neil Rickman, 2004. "Liability, insurance and defensive medicine: new evidence," School of Economics Discussion Papers 0304, School of Economics, University of Surrey.
    • Handle: RePEc:sur:surrec:0304
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    File URL: https://repec.som.surrey.ac.uk/2004/DP03-04.pdf
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    References listed on IDEAS

    as
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    4. Danzon, Patricia M., 2000. "Liability for medical malpractice," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 26, pages 1339-1404, Elsevier.
    5. Smith, Richard J & Blundell, Richard W, 1986. "An Exogeneity Test for a Simultaneous Equation Tobit Model with an Application to Labor Supply," Econometrica, Econometric Society, vol. 54(3), pages 679-685, May.
    6. Daniel Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 353-390.
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    Full references (including those not matched with items on IDEAS)

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    More about this item

    Keywords

    Medical malpractice; defensive care; insurance; litigation;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • K13 - Law and Economics - - Basic Areas of Law - - - Tort Law and Product Liability; Forensic Economics

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