Journal of Policy Analysis and Management · 2025 · Alice J Chen、Michael R. Richards、Rachel Shriver
中文摘要
文献对于医疗事故制度改革在多大程度上影响医生对医疗程序的过度使用（即"防御性医疗"）仍存在分歧。我们通过考察北卡罗来纳州近期一项引入非经济损失赔偿上限的改革，为这一讨论提供了新证据。我们聚焦于医疗事故风险较高、服务强度在很大程度上取决于医生自由裁量的情境：产科医疗。通过将北卡罗来纳州与佛罗里达州的出院数据进行比较，我们发现非经济损失赔偿上限因果性地使剖宫产的可能性平均降低5%，且政策实施五年后效应规模接近7%。医生同时也减少了真空吸引产和产钳助产等其他高强度程序的使用，但通过增加医学引产来维持对出生时机的控制。我们的研究结果表明，北卡罗来纳州赔偿上限带来的剖宫产减少每年可减少支出约460万美元。
Abstract
Abstract The literature remains mixed on the extent to which medical malpractice reforms affect physician overuse of procedures (i.e., “defensive medicine”). We bring new evidence to this discourse by examining a recent reform in North Carolina that introduced caps on noneconomic damages. We focus on a setting where malpractice risk is high and service intensity is strongly subject to physicians’ discretion: obstetrics care. Comparing discharge data from North Carolina to Florida, we show that caps on noneconomic damages causally reduce the likelihood of a cesarean delivery by, on average, 5%, with the effect size nearing 7% five years post‐policy implementation. Physicians also substitute away from other intensive procedures such as vacuum and forceps deliveries but maintain control over the timing of births by increasing medical inductions. Our findings suggest that the reduction in cesarean deliveries due to North Carolina's damage caps can reduce annual spending by approximately $4.6 million.