Medical Malpractice and Family Medicine: Physician Supply, Choices, and Patient Outcomes

• Other Authors: Ellyson, Alice (authoraut)
• Format: Others
• Language: English; English
• Published: Florida State University
• Subjects: Economics
• Online Access: http://purl.flvc.org/fsu/fd/FSU_2016SP_Ellyson_fsu_0071E_13011

The shortage of family medicine physicians is a predominant issue in the medical field. This dissertation investigates whether medical malpractice liability reforms impact defensive medicine among general practice physicians. The first chapter, "Medical Malpractice Liability Reform and Family Medicine Physician Supply," explores the decision made by physicians to decline to provide care that has medical value in order to reduce the risk of malpractice liability. This analysis focuses on behaviors that affect family medicine physician supply by assessing the differential impact of states that adopt medical malpractice reforms compared to those without reforms from 1992- 2007. The reforms of bordering states are used in instrumental variables estimation to account for the endogeneity of reforms. These instruments are strong and valid. Results indicate that noneconomic damage caps, punitive damage caps, and collateral source reform increase the supply of family medicine physicians per state while joint and several liability decreases physician supply. Furthermore, this analysis distinguishes between temporary and permanent reforms and finds that only permanent punitive damage caps have a statistically significant impact on family medicine physician supply. The second chapter, "Movement and Reorganization: Negative Defensive Medicine among Family Medicine Physicians," measures the effect of liability reforms on practice choices of family medicine physicians including location, mode, and service offerings. Existing literature considers the effect of tort reforms on physician supply. However, physicians may employ defensive behaviors that may not be observed when testing for response at the aggregate level. For example, physicians may move from solo practice to group practice to share the liability burden. Physicians can also move their practice to a more defendant friendly legal environment by moving to a different state. They may also decline to provide certain types of care that are associated with a higher risk of medical malpractice suits, like obstetrical care. Using a random sample of family medicine physicians in the United States, this paper models these three choices using multinomial logit and fixed effects logit. Results indicate that family medicine physicians alter their choice of location and practice mode with the implementation of reforms in substantial ways. Lastly, the third chapter, "Short-term and Long-term Effects of Liability Reform on Preventable Disease," models the short-term and long-term effects of liability reform on two patient outcomes, obesity and type II diabetes. Reforms impact these patient outcomes indirectly through changes to both positive and defensive medicine strategies. Reforms that reduce malpractice pressure on physicians will also reduce the practice of negative defensive medicine. This increases access to care and will likely lead to an increase in prevalence rates, initially. However, over time as physicians counsel these previously untreated patients, changes will be made to diet, exercise, and lifestyle. If these changes are effective, patients may lose weight which will decrease the prevalence of obesity and the prevalence of type II diabetes. Models use differences-in-differences and state and time fixed effects to assess this hypothesis. Results indicate that reforms impact defensive medicine, especially avoidance behaviors, with no changes to patient health in the long-run. === A Dissertation submitted to the Department of Economics in partial fulfillment of the requirements for the degree of Doctor of Philosophy. === Fall Semester 2015. === December 9, 2015. === Health Economics, Medical Malpractice, Physician Choices, Tort Law === Includes bibliographical references. === Bruce L. Benson, Professor Directing Dissertation; Patricia Born, University Representative; Anastasia Semykina, Committee Member; Thomas W. Zuehlke, Committee Member.