title: The Impact of State Tort Reforms on Imaging Utilization.
abstract: OBJECTIVE
  Defensive medicine, broadly defined as medical practices that protect physicians from malpractice lawsuits without providing benefits to patients, can lead to wasteful use of health care resources and higher cost. Although physicians cite malpractice liability as an important factor driving their decisions to order imaging tests, little research has been done to examine the systematic impact of liability pressure on overall imaging. The authors examined the extent to which radiography use is influenced by malpractice liability pressure among office-based physicians.
  
  
  METHODS
  Using National Ambulatory Medical Care Survey data from 1999 to 2010, the authors used multivariate difference-in-difference logistic regression to examine the effects of different types of state tort reforms on the probability of radiography orders by primary care physicians (PCPs) and specialists.
  
  
  RESULTS
  The probability that a PCP ordered radiography decreased when states enacted permanent caps on noneconomic damages (-1.0%, P < .01), periodic payment reforms (-1.6%, P < .05), and the total number of tort reforms (-0.5%, P < .05). Specialist physicians were responsive to two reforms: caps on punitive damages (-6.1%, P < .01) and the total number of medical tort laws (-1.2%, P < .01). The passage of new indirect reforms was found to reduce radiography orders for PCPs (-1.8%, P < .05), and the repeal of indirect reforms was found to increase radiography orders for specialists (+3.4%, P < .01).
  
  
  CONCLUSIONS
  State tort reform seems to reduce physicians' ordering of radiography. This analysis also suggests that reforms that make it harder to sue physicians have a stronger impact than reforms that directly reduce physicians' malpractice claim payments.
authors.affiliation: Mathematica Policy Research, Princeton, New Jersey.
authors.forename: Suhui
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Health, Policy and Management, George Washington University, Washington, District of Columbia.
authors.forename: Avi
authors.initials: A
authors.lastname: Dor
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Economics, George Mason University, Fairfax, Virginia.
authors.forename: Darwyyn
authors.initials: D
authors.lastname: Deyo
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia. Electronic address: dhughes@neimanhpi.org.
authors.forename: Danny R
authors.initials: DR
authors.lastname: Hughes
mesh_terms: D003675:Defensive Medicine / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data*; D033161:Government Regulation; D016365:Liability, Legal / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D013219:State Government; D014481:United States; D014600:Utilization Review
keywords: diagnostic imaging; imaging utilization; radiography; tort reform