title: Physician spending and subsequent risk of malpractice claims: observational study.
abstract: OBJECTIVE
  Is a higher use of resources by physicians associated with a reduced risk of malpractice claims?
  
  
  METHODS
  Using data on nearly all admissions to acute care hospitals in Florida during 2000-09 linked to malpractice history of the attending physician, this study investigated whether physicians in seven specialties with higher average hospital charges in a year were less likely to face an allegation of malpractice in the following year, adjusting for patient characteristics, comorbidities, and diagnosis. To provide clinical context, the study focused on obstetrics, where the choice of caesarean deliveries are suggested to be influenced by defensive medicine, and whether obstetricians with higher adjusted caesarean rates in a year had fewer alleged malpractice incidents the following year.
  
  
  CONCLUSIONS
  The data included 24,637 physicians, 154,725 physician years, and 18,352,391 hospital admissions; 4342 malpractice claims were made against physicians (2.8% per physician year). Across specialties, greater average spending by physicians was associated with reduced risk of incurring a malpractice claim. For example, among internists, the probability of experiencing an alleged malpractice incident in the following year ranged from 1.5% (95% confidence interval 1.2% to 1.7%) in the bottom spending fifth ($19,725 (£12,800; €17,400) per hospital admission) to 0.3% (0.2% to 0.5%) in the top fifth ($39,379 per hospital admission). In six of the specialties, a greater use of resources was associated with statistically significantly lower subsequent rates of alleged malpractice incidents. A principal limitation of this study is that information on illness severity was lacking. It is also uncertain whether higher spending is defensively motivated.
  
  
  CONCLUSIONS
  Within specialty and after adjustment for patient characteristics, higher resource use by physicians is associated with fewer malpractice claims.
  
  
  BACKGROUND
  This study was supported by the Office of the Director, National Institutes of Health (grant 1DP5OD017897-01 to ABJ) and National Institute of Aging (R37 AG036791 to JB). The authors have no competing interests or additional data to share.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA; and Massachusetts General Hospital, Boston, MA, USA National Bureau of Economic Research, Cambridge, MA, USA jena@hcp.med.harvard.edu.
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Jena
authors.affiliation: Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Lena
authors.initials: L
authors.lastname: Schoemaker
authors.affiliation: National Bureau of Economic Research, Cambridge, MA, USA Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
authors.affiliation: National Bureau of Economic Research, Cambridge, MA, USA Department of Emergency Medicine and Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Seabury
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data; D005431:Florida; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007351:Insurance, Liability / Q000706:statistics & numerical data*; D008318:Malpractice / Q000191:economics / Q000706:statistics & numerical data*