title: Impact of malpractice caps on use and outcomes of radical cystectomy for bladder cancer: data from the surveillance, epidemiology, and end results program.
abstract: OBJECTIVE
  The impact of malpractice awards on insurance premiums and health care delivery generates much concern. To our knowledge no data exist regarding the impact of caps, or upper limits, on awards for noneconomic damages (also termed pain and suffering) on health care delivery patterns or outcomes. We investigated the effect of caps on the use of and outcomes following aggressive surgical treatment (radical cystectomy) in patients with bladder cancer.
  
  
  METHODS
  We performed a retrospective cohort study of patients with bladder cancer who underwent radical cystectomy, identified from the Surveillance, Epidemiology, and End Results (SEER) Program database. Cystectomy rates and post-cystectomy disease specific survival were compared between SEER regions with and without a cap, while controlling for other variables.
  
  
  RESULTS
  A significantly greater proportion of patients with stages III and IV bladder cancer underwent cystectomy in SEER regions with a cap. Cap status was a significant predictor of survival from bladder cancer.
  
  
  CONCLUSIONS
  Radical cystectomy for bladder cancer is performed more often even for advanced bladder cancer in geographic regions with a cap with a positive impact on survival. The institution of caps may have beneficial effects on patterns of health care beyond that of merely decreasing insurance premium costs.
authors.affiliation: Department of Urology, University of Iowa, Iowa City, USA. badrinathkonety@uiowa.edu
authors.forename: Badrinath R
authors.initials: BR
authors.lastname: Konety
authors.forename: Vibhu
authors.initials: V
authors.lastname: Dhawan
authors.forename: Veersathpurush
authors.initials: V
authors.lastname: Allareddy
authors.forename: Sue A
authors.initials: SA
authors.lastname: Joslyn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D035881:Compensation and Redress / Q000331:legislation & jurisprudence*; D015653:Cystectomy / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007351:Insurance, Liability / Q000191:economics* / Q000331:legislation & jurisprudence; D008297:Male; D008318:Malpractice / Q000191:economics* / Q000331:legislation & jurisprudence; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics* / Q000401:mortality*; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data*; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014600:Utilization Review / Q000706:statistics & numerical data