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The effect of medical malpractice liability on rate of referrals received by specialist physicians

Published online by Cambridge University Press:  26 March 2013

Xiao Xu ,
Stephen J. Spurr ,
Bin Nan  and
A. Mark Fendrick
Xiao Xu*
Affiliation:
Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
Stephen J. Spurr
Affiliation:
Professor, Department of Economics, Wayne State University, Detroit, MI, USA
Bin Nan
Affiliation:
Professor, Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
A. Mark Fendrick
Affiliation:
Professor, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
*
Correspondence to: Xiao Xu, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 310 Cedar Street, LSOG 205B, PO Box 208063 New Haven, CT 06520, USA. Email: xiao.xu@yale.edu
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Abstract

Using nationally representative data from the United States, this paper analyzed the effect of a state's medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state's malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state's medical malpractice environment on physicians’ referral behavior.

Type
Articles
Information
Health Economics, Policy and Law , Volume 8 , Issue 4 , October 2013 , pp. 453 - 475
Copyright
Copyright © Cambridge University Press 2013 

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References

Avraham, R. (2010), ‘Database of state tort law reforms (DSTLR) 3rd 1980–2008’, http://www.utexas.edu/law/faculty/ravraham/dstlr.html [10 August 2010].CrossRefGoogle Scholar
Axon, A., Hassan, M., Niv, Y., Beglinger, C.Rokkas, T. (2008), ‘Ethical and legal implications in seeking and providing a second medical opinion’, Digestive Diseases, 26(1): 11–17.CrossRefGoogle ScholarPubMed
Baicker, K., Fisher, E. S.Chandra, A. (2007), ‘Malpractice liability costs and the practice of medicine in the medicare program’, Health Affairs (Millwood), 26(3): 841–852.CrossRefGoogle ScholarPubMed
Baldwin, L. M., Hart, L. G., Lloyd, M., Fordyce, M.Rosenblatt, R. A. (1995), ‘Defensive medicine and obstetrics’, Journal of the American Medical Association, 274(20): 1606–1610.CrossRefGoogle ScholarPubMed
Barnett, M. L., Song, Z.Landon, B. E. (2012), ‘Trends in physician referrals in the United States, 1999–2009’, Archives of Internal Medicine, 172(2): 163–170.CrossRefGoogle ScholarPubMed
Berenson, R. A., Kuo, S., May, J. H. (2003), Medical Malpractice Liability Crisis Meets Markets: Stress in Unexpected Places Issue Brief No. 68. Washington, DC: Center for Studying Health System Change. http://www.hschange.com/CONTENT/605.Google Scholar
Bismark, M.Paterson, R. (2006), ‘No-fault compensation in New Zealand: harmonizing injury compensation, provider accountability, and patient safety’, Health Affairs, 25(1): 278–283.CrossRefGoogle ScholarPubMed
Bourguet, C., Gilchrist, V.McCord, G. (1998), ‘The consultation and referral process. A report from NEON. Northeastern Ohio Network Research Group’, Journal of Family Practice, 46(1): 47–53.Google ScholarPubMed
Burt, C. W., McCaig, L. F., Rechtsteiner, E. A. (2007), ‘Ambulatory medical care utilization estimates for 2005’. Advance Data from Vital and Health Statistics. No. 388. Hyattsville, MD: National Center for Health Statistics. http://www.cdc.gov/nchs/data/ad/ad388.pdf.Google Scholar
Byrd, J. C.Moskowitz, M. A. (1987), ‘Outpatient consultation: interaction between the general internist and the specialist’, Journal of General Internal Medicine, 2(2): 93–98.CrossRefGoogle ScholarPubMed
Carey, T. S., Garrett, J., Jackman, A., McLaughlin, C., Fryer, J.Smucker, D. R. (1995), ‘The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project’, New England Journal of Medicine, 333(14): 913–917.CrossRefGoogle ScholarPubMed
Cunningham, W.Dovey, S. (2006), ‘Defensive changes in medical practice and the complaints process: a qualitative study of New Zealand doctors’, New Zealand Medical Journal, 119(1244): U2283.Google ScholarPubMed
Danzon, P. M., Epstein, A. J.Johnson, S. J. (2004), ‘The “Crisis” in medical malpractice insurance’, in R. Harris and R. Litan (eds), Brookings-Wharton Papers on Financial Services, Washington, DC: Brookings Institution Press, 55–96.Google Scholar
Durrance, C. P.Hankins, S. (2011), ‘Is direct access to obstetricians/gynecologists effective at improving maternal health behaviors?’, Health Services Research, 46(4): 1243–1258.CrossRefGoogle ScholarPubMed
Forrest, C. B.Reid, R. J. (1997), ‘Passing the baton: HMOs’ influence on referrals to specialty care’, Health Affairs (Millwood), 16(6): 157–162.CrossRefGoogle ScholarPubMed
Forrest, C. B.Reid, R. J. (2001), ‘Prevalence of health problems and primary care physicians’ specialty referral decisions’, Journal of Family Practice, 50(5): 427–432.Google ScholarPubMed
Forrest, C. B., Nutting, P. A., Starfield, B.von Schrader, S. (2002), ‘Family physicians’ referral decisions: results from the aspn referral study’, Journal of Family Practice, 51(3): 215–222.Google ScholarPubMed
Forrest, C. B., Shadmi, E., Nutting, P. A.Starfield, B. (2007), ‘Specialty referral completion among primary care patients: results from the ASPN Referral Study’, Annals of Family Medicine, 5(4): 361–367.CrossRefGoogle ScholarPubMed
Forrest, C. B., Majeed, A., Weiner, J. P., Carroll, K.Bindman, A. B. (2002), ‘Comparison of specialty referral rates in the United Kingdom and the United States: retrospective cohort analysis’, British Medical Journal, 325(7360): 370–371.CrossRefGoogle ScholarPubMed
Forrest, C. B., Majeed, A., Weiner, J. P., Carroll, K.Bindman, A. B. (2003), ‘Referral of children to specialists in the United States and the United kingdom’, Archives of Pediatrics & Adolescent Medicine, 157(3): 279–285.CrossRefGoogle ScholarPubMed
Forrest, C. B., Nutting, P. A., von Schrader, S., Rohde, C.Starfield, B. (2006), ‘Primary care physician specialty referral decision making: patient, physician, and health care system determinants’, Medical Decision Making, 26(1): 76–85.CrossRefGoogle ScholarPubMed
Forrest, C. B., Glade, G. B., Baker, A. E., Bocian, A., von Schrader, S.Starfield, B. (2000), ‘Coordination of specialty referrals and physician satisfaction with referral care’, Archives of Pediatrics and Adolescent Medicine, 154(5): 499–506.CrossRefGoogle ScholarPubMed
Fournier, G. M.McInnes, M. M. (2002), ‘The effects of managed care on medical referrals and the quality of specialty care’, Journal of Industrial Economics, 50(4): 457–473.CrossRefGoogle Scholar
Franks, P.Clancy, C. M. (1997), ‘Referrals of adult patients from primary care: demographic disparities and their relationship to HMO insurance’, Journal of Family Practice, 45(1): 47–53.Google ScholarPubMed
Franks, P., Williams, G. C., Zwanziger, J., Mooney, C.Sorbero, M. (2000), ‘Why do physicians vary so widely in their referral rates?’, Journal of Genenral Internal Medicine, 15(3): 163–168.CrossRefGoogle ScholarPubMed
Garr, D. R.Marsh, F. J. (1986), ‘Medical malpractice and the primary care physician: lowering the risks’, Southern Medical Journal, 79(10): 1280–1284.CrossRefGoogle ScholarPubMed
Glyngdal, P., Sørensen, P.Kistrup, K. (2002), ‘Non-compliance in community psychiatry: failed appointments in the referral system to psychiatric outpatient treatment’, Nordic Journal of Psychiatry, 56(2): 151–156.CrossRefGoogle ScholarPubMed
Green, J. R. (1978), ‘Medical malpractice and the propensity to litigate’, in S. Rottenberg (ed.), The Economics of Medical Malpractice, Washington, DC: the American Enterprise Institute for Public Policy Research, 193–209.Google Scholar
Greenfield, S., Nelson, E. C., Zubkoff, M., Manning, W., Rogers, W., Kravitz, R. L., Keller, A., Tarlov, A. R.Ware, J. E. Jr. (1992), ‘Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study’, Journal of the American Medical Association, 267(12): 1624–1630.CrossRefGoogle ScholarPubMed
Guirguis-Blake, J., Fryer, G. E., Jr.Phillips, R. L., Szabat, R.Green, L. A. (2006), ‘The US Medical Liability System: evidence for legislative reform’, Annals of Family Medicine, 4(3): 240–246.CrossRefGoogle ScholarPubMed
Hacker, K. A., Weintraub, T. A., Fried, L. E.Ashba, J. (1997), ‘Role of school-based health centers in referral completion’, Journal of Adolescent Health, 21(5): 328–334.CrossRefGoogle ScholarPubMed
Hamilton, W., Round, A.Sharp, D. (2002), ‘Patient, hospital, and general practitioner characteristics associated with non-attendance: a cohort study’, British Journal of General Practice, 52(477): 317–319.Google ScholarPubMed
Hartz, A., Deber, R., Bartholomew, M.Midtling, J. (1993), ‘Physician characteristics affecting referral decisions following an exercise tolerance test’, Archives of Family Medicine, 2(5): 513–519.CrossRefGoogle ScholarPubMed
Health Resources and Services Administration (2010), Resources: Public Use Data File, Rockville, MD: US Department of Health and Human Services. http://www.npdb-hipdb.hrsa.gov/resources/publicData.jsp.Google Scholar
Hsiao, C. J., Cherry, D. K., Beatty, P. C., Rechtsteiner, E. A. (2010), National Ambulatory Medical Care Survey: 2007 Summary. National Health Statistics Reports: No. 27, Hyattsville, MD: National Center for Health Statistics. http://www.cdc.gov/nchs/data/nhsr/nhsr027.pdf.Google Scholar
Iversen, T.Luras, H. (2000), ‘The effect of capitation on GPs’ referral decisions’, Health Economics, 9(3): 199–210.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
Iverson, G. D., Coleridge, S. T., Fulda, K. G.Licciardone, J. C. (2005), ‘What factors influence a family physician's decision to refer a patient to a specialist?’, Rural Remote Health, 5(3): 413.Google ScholarPubMed
Johnson, A. C., Kroeger, H. H., Altman, I., Clark, D. A.Sheps, C. G. (1965), ‘The office practice of internists. 3. Characteristics of patients’, Journal of the American Medical Association, 193: 916–922.CrossRefGoogle ScholarPubMed
Kain, Z. N.Caldwell-Andrews, A. A. (2006), ‘What pediatricians should know about child-related malpractice payments in the United States’, Pediatrics, 118(2): 464–468.CrossRefGoogle ScholarPubMed
Kessler, D. P.McClellan, M. B. (1997), ‘The effects of malpractice pressure and liability reforms on physicians’ perceptions of medical care’, Law and Contemporary Problems, 60(1): 81–106.CrossRefGoogle Scholar
Kinney, E. D. (1995), ‘Malpractice reform in the 1990s: past disappointments, future success?’, Journal of Health Politics, Policy and Law, 20(1): 99–135.CrossRefGoogle ScholarPubMed
Koil, C. E., Everett, J. N., Hoechstetter, L., Ricer, R. E.Huelsman, K. M. (2003), ‘Differences in physician referral practices and attitudes regarding hereditary breast cancer by clinical practice location’, Genetics in Medicine, 5(5): 364–369.CrossRefGoogle ScholarPubMed
Kues, J. R., Sacks, J. G., Davis, L. J.Smith, R. (1991), ‘The value of a new family practice center patient to the academic medical center’, Journal of Family Practice, 32(6): 571–575.Google Scholar
McLean, T. R. (2004), ‘Why do physicians who treat lung cancer get sued?’, Chest, 126(5): 1672–1679.CrossRefGoogle ScholarPubMed
Medical Liability Monitor (2007), ‘Rate Survey’, Methodology: Rate report presents state-by-state view of changing market, 32(10): 1–2.Google Scholar
Mello, M. M., Williams, C. H. (2006), ‘Medical Malpractice: Impact of the Crisis and Effect of State Tort Reforms’. The Synthesis Project: New Insights from Research Results. The Synthesis Project No. 10. Princeton, NJ: Robert Wood Johnson Foundation. http://www.rwjf.org/pr/product.jsp?id=15168.Google Scholar
Moore, A. T.Roland, M. O. (1989), ‘How much variation in referral rates among general practitioners is due to chance?’, British Medical Journal, 298(6672): 500–502.CrossRefGoogle ScholarPubMed
National Center for Health Workforce Analysis (2008), Area Resource File, Rockville, MD: US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions.Google Scholar
Nutting, P. A., Franks, P.Clancy, C. M. (1992), ‘Referral and consultation in primary care: do we understand what we're doing?’, Journal of Family Practice, 35(1): 21–23.Google ScholarPubMed
O'Donnell, C. A. (2000), ‘Variation in GP referral rates: what can we learn from the literature?’, Family Practice, 17(6): 462–471.CrossRefGoogle ScholarPubMed
Office of the Assistant Secretary for Planning and Evaluation (2002), Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Costs by Fixing Our Medical Liability System, Washington, DC: US Department of Health and Human Services. http://aspe.hhs.gov/daltcp/reports/litrefm.htm.Google Scholar
Phillips, R. L. Jr.Bartholomew, L. A., Dovey, S. M., Fryer, G. E. Jr.Miyoshi, T. J.Green, L. A. (2004), ‘Learning from malpractice claims about negligent, adverse events in primary care in the United States’, Quality and Safety in Health Care, 13(2): 121–126.CrossRefGoogle ScholarPubMed
Pinsker, J., Phillips, R. S., Davis, R. B.Iezzoni, L. I. (1995), ‘Use of follow-up services by patients referred from a walk-in unit: how can patient compliance be improved?’, American Journal of Medical Quality, 10(2): 81–87.CrossRefGoogle ScholarPubMed
Piterman, L.Koritsas, S. (2005), ‘Part II. General practitioner – specialist referral process’, Internal Medicine Journal, 35(8): 491–496.CrossRefGoogle ScholarPubMed
Rosemann, T., Wensing, M., Rueter, G.Szecsenyi, J. (2006), ‘Referrals from general practice to consultants in germany: if the GP is the initiator, patients’ experiences are more positive’, BMC Health Services Research, 6: 5.CrossRefGoogle ScholarPubMed
Schaffer, W. A.Holloman, F. C. Jr.(1985), ‘Consultation and referral between physicians in new medical practice environments’, Annals of Internal Medicine, 103(4): 600–605.CrossRefGoogle ScholarPubMed
Schneeweiss, R., Ellsbury, K., Hart, L. G.Geyman, J. P. (1989), ‘The economic impact and multiplier effect of a family practice clinic on an academic medical center’, Journal of the American Medical Association, 262(3): 370–375.CrossRefGoogle Scholar
Shortell, S. M.Anderson, O. W. (1971), ‘The physician referral process: a theoretical perspective’, Health Services Research, 6(1): 39–48.Google ScholarPubMed
Sloan, F. A., Hickson, G. B.Zhang, H. H. (1997), ‘Tort Liability and Obstetricians’ Care Levels’, International Review of Law and Economics, 17(2): 245–260.CrossRefGoogle Scholar
Studdert, D. M., Mello, M. M.Brennan, T. A. (2004), ‘Medical malpractice’, New England Journal of Medicine, 350(3): 283–292.CrossRefGoogle ScholarPubMed
Studdert, D. M., Mello, M. M., Sage, W. M., DesRoches, C. M., Peugh, J., Zapert, K.Brennan, T. A. (2005), ‘Defensive medicine among high-risk specialist physicians in a volatile malpractice environment’, Journal of the American Medical Association, 293(21): 2609–2617.CrossRefGoogle Scholar
Tabenkin, H., Oren, B., Steinmetz, D., Tamir, A.Kitai, E. (1998), ‘Referrals of patients by family physicians to consultants: a survey of the israeli family practice research network’, Family Practice, 15(2): 158–164.CrossRefGoogle ScholarPubMed
The Johns Hopkins ACG® System (2013), About the ACG System. http://www.acg.jhsph.org/index.php?option=com_content&view=article&id=46&Itemid=366 [23 January 2013].Google Scholar
Thorpe, K. E. (2004), ‘The medical malpractice “Crisis”: recent trends and the impact of state tort reforms’, Health Affairs (Millwood) Suppl Web Exclusives W4-20-30.CrossRefGoogle ScholarPubMed
US Bureau of Labor Statistics (2010), ‘CPI Database’, http://www.bls.gov/cpi/#data, accessed 31 July 2010.Google Scholar
United States General Accounting Office (2000), National Practitioner Data Bank: Major Improvements Are Needed to Enhance Data Bank's Reliability, Washington, DC: United States General Accounting Office. http://www.gao.gov/new.items/d01130.pdf.Google Scholar
Vogt, H. B.Amundson, L. H. (1988), ‘Family physician consultation/referral patterns’, Journal of the American Board of Family Practice, 1(2): 106–111.Google ScholarPubMed
Weiner, M., Perkins, A. J.Callahan, C. M. (2010), Errors in completion of referrals among older urban adults in ambulatory care’, Journal of Evaluation in Clinical Practice, 16(1): 76–81.CrossRefGoogle ScholarPubMed
Wilbert, J. R.Fulero, S. M. (1988), ‘Impact of malpractice litigation on professional psychology: survey of practitioners’, Professional Psychology: Research and Practice, 19(4): 379–382.CrossRefGoogle Scholar
Wu, C. H., Kao, J. C.Chang, C. J. (1996), ‘Analysis of outpatient referral failures’, Journal of Family Practice, 42(5): 498–502.Google ScholarPubMed
Yang, T. Y., Studdert, D. M., Subramanian, S. V.Mello, M. M. (2008), ‘A longitudinal analysis of the impact of liability pressure on the supply of obstetrics-gynecologists’, Journal of Empirical Legal Studies, 5(1): 21–53.CrossRefGoogle Scholar
Zuckerman, K. E., Perrin, J. M., Hobrecker, K.Donelan, K. (2013), ‘Barriers to specialty care and specialty referral completion in the community health center setting’, Journal of Pediatrics, 162(2): 409–414.CrossRefGoogle ScholarPubMed
Zuckerman, K. E., Cai, X., Perrin, J. M.Donelan, K. (2011a), ‘Incomplete specialty referral among children in community health centers’, Journal of Pediatrics, 158(1): 24–30.CrossRefGoogle ScholarPubMed
Zuckerman, K. E., Nelson, K., Bryant, T. K., Hobrecker, K., Perrin, J. M.Donelan, K. (2011b), ‘Specialty referral communication and completion in the community health center setting’, Academic Pediatrics, 11(4): 288–296.CrossRefGoogle ScholarPubMed