Market watch: Changes in physician supply and scope of practice during a malpractice crisis: Evidence from Pennsylvania

Health Affairs

Volumn 26, Issue 3, 2007, Pages

  Mello, Michelle M ^a   Studdert, David M ^b   Schumi, Jennifer ^c   Brennan, Troyen A ^d   Sage, William M ^e  

^a HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^b UNIVERSITY OF MELBOURNE   (Australia)

^c University of Iowa   (United States)

^d AETNA   (United States)

^e UNIVERSITY OF TEXAS AT AUSTIN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMICS; HUMAN; INSURANCE; MALPRACTICE; MEDICINE; PHYSICIAN; PROFESSIONAL PRACTICE; STATISTICS; UNITED STATES;

HUMANS; INSURANCE, LIABILITY; MALPRACTICE; PENNSYLVANIA; PHYSICIANS; PROFESSIONAL PRACTICE; SPECIALTIES, MEDICAL;

EID: 34248545339     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.3.w425     Document Type: Article

References (48)

1. M.M. Mello, "Understanding Medical Malpractice Insurance: A Primer," January 2006, http://www.rwjf.org/publications/synthesis/ reports_and_briefs/pdf/no8_primer.pdf (accessed 20 March 2007).
2. R.R. Bovbjerg and A. Bartow, "Understanding Pennsylvania's Medical Malpractice Crisis: Facts about Liability Insurance, the Legal System, and Health Care in Pennsylvania" (Philadelphia: Project on Medical Liability in Pennsylvania, June 2003).
3. U.S. Government Accountability Office, Medical Malpractice: Implications of Rising Premiums on Access to Health Care, August 2003, http://www.gao.gov/new.items/d03836.pdf (accessed 21March 2006);
4. and M.M. Mello et al., "Effects of a Malpractice Crisis on Specialist Supply and Patient Access to Care," Annals of Surgery 242, no. 5 (2005): 621-628.
5. GAO, Medical Malpractice.
6. Mello et al., "Effects of a Malpractice Crisis."
7. M.M. Mello et al., "Hospitals' Behavior in a Tort Crisis: Observations from Pennsylvania," Health Affairs 22, no. 6 (2003): 225-233. We conducted forty-one interviews in Pennsylvania with officials at thirteen medical specialty societies, six county medical societies, a hospital association, nine hospitals, two health plans, and one state government agency; we asked informants to identify the year of onset of the malpractice crisis.
8. F.A. Sloan, "Public Medical Malpractice Insurance" (Philadelphia: Project on Medical Liability in Pennsylvania, March 2004).
9. K. Grumbach et al., "The Challenge of Defining and Counting Generalist Physicians: An Analysis of Physician Masterfile Data," American Journal of Public Health 85, no. 10 (1995): 1402-1407;
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11. D.R. Rittenhouse et al., "No Exit: An Evaluation of Measures of Physician Attrition," Health Services Research 39, no. 5 (2004): 1571-1588.
12. Mello et al., "Effects of a Malpractice Crisis";
13. and D.M. Studdert et al., "Defensive Medicine among High-Risk Specialist Physicians in a Volatile Malpractice Environment," Journal of the American Medical Association 293, no. 21 (2005): 2609-2617.
14. Population Division, U.S. Census Bureau, "Table 1: Annual Estimates of the Population for the United States and States, and for Puerto Rico: April 1, 2000 to July 1, 2004," 22 December 2004, http://www.census.gov/popest/ states/tables/NST-EST2004-01.pdf (accessed 20March 2007);
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16. Changes to MCARE's data coding practices in 1997 necessitated omission of the 1996-97 transition from all analyses.
17. Three specialties (dermatology, psychology, and radiology)were excluded from the shifts analysis because of the coding change; three others were excluded because all policies in those specialties were classified as eithermajor procedures (emergency medicine and neurosurgery) or minor procedures (anesthesia); and shifts in obstetricsgynecology were analyzed beginning in 1997.
18. J.M. Lachin, Biostatistical Methods: The Assessment of Relative Risks (New York: Wiley, 2000).
19. For trend-line plot, see the online appendix at http://content. healthaffairs.org/cgi/content/full/hlthaff.26.3.w425/DC2.
20. Ibid., for premiums and specialist supply.
21. Ibid., for full results.
22. Ibid.
23. Mello et al., "Effects of a Malpractice Crisis."
24. Ibid.;
25. J. Brehm et al., "Physician Supply in Key Medical Specialties in West Virginia Hospitals, 2001-2004," West Virginia Medical Journal 100, no. 4 (2004): 132-135;
26. R.G. Brooks et al., "Impact of the Medical Professional Liability Insurance Crisis on Access to Care in Florida," Archives of Internal Medicine 164, no. 20 (2004): 2217-2222;
27. and M.M. Mello and C.N. Kelly, "Effects of a Professional Liability Crisis on Residents' Practice Decisions," Obstetrics and Gynecology 105, no. 6 (2005): 1287-1295.
28. Mello et al., "Effects of a Malpractice Crisis."
29. Ibid.
30. GAO, Medical Malpractice.
31. Mello et al., "Effects of a Malpractice Crisis."
32. Rittenhouse et al., "No Exit."
33. See the online appendix (Note 15) for summaries of findings in D.P. Kessler, W.M. Sage, and D.J. Becker, "Impact of Malpractice Reforms on the Supply of Physician Services," Journal of the American Medical Association 293, no. 21 (2005): 2618-2625;
34. F.J. Hellinger and W.E. Encinosa, "The Impact of State Laws Limiting Malpractice Awards on the Geographic Distribution of Physicians," 2003, http://www.ahrq.gov/research/tortcaps/tortcaps.htm (accessed 11 April 2007);
35. M.P. Gius, "An Examination of the Determinants of Physician Supply at the State Level," Journal of Business and Economic Studies 6, no. 1 (2000): 73-79;
36. K. Baicker and A. Chandra, "The Effect of Malpractice Liability on the Delivery of Health Care," in Frontiers in Health Policy Research, vol. 8, ed. D.M. Cutler and A.M. Garber, abstract available online at http://www.bepress.com/fhep/8/4 (accessed 19 April 2007);
37. B.B. Erus, "Malpractice Liability Crisis and Physician Location Choice" (Working paper, Northwestern University, 2004);
38. D. Matsa, "Does Liability Keep the Doctor Away? Evidence from Tort Reform Damage Caps" Journal of Legal Studies (forthcoming);
39. W.E. Encinosa and F.J. Hellinger, "Have State Caps on Malpractice Awards Increased the Supply of Physicians?" Health Affairs 24 (2005): w250-w258 (published online 31 May 2005; 10.1377/ hlthaff.w5.250);
40. J. Klick and T. Stratmann, "Medical Malpractice Reformand Physicians in High Risk Specialities" (Working paper, Florida State University College of Law, 2006);
41. and E. Helland and M.H. Showalter, "The Impact of Liability on the Physician Labor Market" (Working paper, RAND, 2006).
42. Pennsylvania Department of Health, "Birth and Death Statistics, 1990-2005," 2 February 2007, http://www.dsf.health.state.pa.us/health/cwp/ view.asp?a=175&Q=201652 (accessed 12 April 2007).
43. Baicker and Chandra, "The Effect of Malpractice Liability."
44. D. Dranove and A. Gron, "Effects of the Malpractice Crisis on Access to and Incidence of High-Risk Procedures: Evidence from Florida," Health Affairs 24, no. 3 (2005): 802-810.
45. B.R. Konety et al., "Impact of Malpractice Caps on Use and Outcomes of Radical Cystectomy for Bladder Cancer: Data from the Surveillance, Epidemiology, and End Results Program," Journal of Urology 173, no. 6 (2005): 2085-2089.
46. Matsa, "Does Liability Keep the Doctor Away?"
47. M.M. Mello et al., "Caring for Patients in a Malpractice Crisis: Physician Satisfaction and Quality of Care," Health Affairs 23, no. 4 (2004): 42-53;
48. and Common Good and Harris Interactive Inc., "Fear of Litigation Study: The Impact on Medicine," 11 April 2002, http://cgood.org/assets/ attachments/57.pdf (accessed 21March 2006).