Cano-Urbina Javier, Montanera Daniel
Department of Economics, Florida State University, 113 College Loop, 257 Bellamy Bldg, Tallahassee, FL, 32306, USA.
Institute of Health Administration, Georgia State University, 35 Broad St. NW, Suite 805, Atlanta, GA, 30302, USA.
Int J Health Econ Manag. 2017 Mar;17(1):103-112. doi: 10.1007/s10754-016-9202-8. Epub 2016 Nov 1.
Investigations into the existence and impact of defensive medicine in obstetrics have produced mixed and often conflicting implications. The most widely-cited and accepted results in this literature find that less severe malpractice environments cause an increase in the use of cesarean section. This has been interpreted as "offensive medicine"; taking advantage of lenient malpractice environments by providing unnecessary services in order to raise revenue. In this article we show that an assumption concerning births with an unknown method of delivery, which is not explicitly stated in the literature, is pivotal in obtaining these results. Using data on tort reforms and birth outcomes from 1989 to 2001 in 24 US states, we show that for the 98.4% of births with a confirmed method of delivery, the estimated effects of tort reform on C-section rates are insignificant. Therefore, without this assumption, there is little evidence to support an interpretation of offensive medicine.
对产科防御性医疗行为的存在及其影响所做的调查得出了复杂且往往相互矛盾的结论。该文献中被引用最广泛且被认可的结果发现，医疗事故环境不那么严峻会导致剖宫产率上升。这被解读为“进攻性医疗行为”；利用宽松的医疗事故环境，通过提供不必要的服务来增加收入。在本文中，我们表明，文献中未明确阐述的一个关于分娩方式未知的分娩情况的假设，在得出这些结果方面起着关键作用。利用1989年至2001年美国24个州的侵权法改革和分娩结果数据，我们发现，对于98.4%分娩方式已确定的分娩情况，侵权法改革对剖宫产率的估计影响并不显著。因此，没有这个假设，几乎没有证据支持对进攻性医疗行为的这种解读。
