title: Does Experience Rating Improve Obstetric Practices? Evidence from Italy.
abstract: Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. 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 analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. 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 (7-11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream skimming.
authors.affiliation: ETH Zurich, Zurich, Switzerland.
authors.forename: Sofia
authors.initials: S
authors.lastname: Amaral-Garcia
authors.affiliation: University of Economics, Prague, CERGE-EI, Prague, Czech Republic.
authors.forename: Paola
authors.initials: P
authors.lastname: Bertoli
authors.affiliation: Copenhagen Business School, Baffi Center, CEIS, and CIFREL.
authors.forename: Veronica
authors.initials: V
authors.lastname: Grembi
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007351:Insurance, Liability / Q000191:economics / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D008318:Malpractice / Q000191:economics / Q000706:statistics & numerical data*; D017059:Models, Econometric; D009774:Obstetrics / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics / Q000453:epidemiology
keywords: C-sections JEL K13; I13; K32; experience rating; medical liability insurance; scheduled damages