Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities in Italy

Amaral-Garcia SofiaBertoli PaolaGrembi Veronica
CEIS Research Paper
Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences and difference-in-discontinuities analyses. We find that the increase in medical malpractice pressure is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained by a reduction in the discretion of obstetric decision making rather than by patient cream skimming.
Number: 342
Keywords: Experience rating, Medical liability insurance, Difference-in-discontinuities, C-sections, Scheduled damages
JEL codes: K13; K32; I13
Volume: 13
Issue: 4
Date: Friday, April 17, 2015
Revision Date: Friday, April 17, 2015