How Threat of Lawsuits Affects Tests and Procedures in Obstetrics

Trends in medical malpractice risk and defensive medicine

From 1995 to 1998, researchers at the Urban Institute documented trends in the medical malpractice environment and demonstrated how the malpractice environment affects defensive medicine in obstetrics practice.

Researchers classify low-value tests and procedures, performed more for legal than medical reasons, as "positive" defensive medicine. Avoidance of high-risk patients or procedures is considered to be "negative" defensive medicine.

Project researchers focused on the question of whether higher malpractice risk leads to more Cesarean sections (positive defensive medicine) or to diminished access to obstetric care for high-risk patients (negative defensive medicine).

They examined the effect of liability concerns on Cesarean section rates, analyzed the effects of liability on access to obstetrical care, and conducted a case study of how liability concerns affect the practice of obstetrics in managed care.

Key Findings:

  • Physicians practice defensive medicine in obstetrics, but the impact of increased Cesarean sections resulting from malpractice fears on total obstetric care costs is small.
  • Physicians' defensive response varies with the socioeconomic status of the mother; greater use of Cesarean sections occurs in the lower socioeconomic groups.
  • There is a considerable premium penalty associated with providing obstetric services.
  • Physicians practicing in different states, and different specialists within a state, may face very different malpractice premium costs.
  • Reform of tort law (injury lawsuits involving liability for damage or injury, including the possibility of punitive damage awards) may be necessary, but would not be sufficient to reduce problems associated with defensive medicine.
  • Participation in managed care can affect providers' liability on the grounds that professional judgment was affected by the economic incentives or rules of managed care.

    In addition, managed care patients are more likely to sue than patients in other health care plans because they mistrust providers or feel shortchanged under managed care.