Kessler Daniel P, McClellan Mark B
Graduate School of Business, Stanford University, CA 94305, USA.
J Health Econ. 2002 Nov;21(6):931-55. doi: 10.1016/s0167-6296(02)00076-0.
Previous research suggests that "direct" reforms to the liability system-reforms designed to reduce the level of compensation to potential claimants-reduce medical expenditures without important consequences for patient health outcomes. We extend this research by identifying the mechanisms through which reforms affect the behavior of health care providers. Although we find that direct reforms improve medical productivity primarily by reducing malpractice claims rates and compensation conditional on a claim, our results suggest that other policies that reduce the time spent and the amount of conflict involved in defending against a claim can also reduce defensive practices substantially. In addition, we find that "malpractice pressure" has a more significant impact on diagnostic rather than therapeutic treatment decisions. Our results provide an empirical foundation for simulating the effects of untried malpractice reforms on health care expenditures and outcomes, based on their predicted effects on the malpractice pressure facing medical providers.
以往的研究表明，责任制度的“直接”改革——旨在降低对潜在索赔人的赔偿水平的改革——能降低医疗支出，且对患者健康结果没有重大影响。我们通过确定改革影响医疗服务提供者行为的机制来扩展这项研究。尽管我们发现直接改革主要通过降低医疗事故索赔率以及索赔后的赔偿来提高医疗生产率，但我们的结果表明，其他能够减少应诉时间和冲突量的政策也能大幅减少防御性医疗行为。此外，我们发现“医疗事故压力”对诊断性而非治疗性治疗决策的影响更大。我们的结果为基于对医疗服务提供者面临的医疗事故压力的预测影响，模拟未经尝试的医疗事故改革对医疗支出和结果的影响提供了实证基础。
