Konetzka R Tamara, Sharma Hari, Park Jeongyoung
1 The University of Chicago, IL, USA.
2 The George Washington University, USA.
Inquiry. 2018 Jan-Dec;55:46958018787995. doi: 10.1177/0046958018787995.
An ongoing concern about medical malpractice litigation is that it may induce provider exit, potentially affecting consumer welfare. The nursing home sector is subject to substantial litigation activity but remains generally understudied in terms of the effects of litigation, due perhaps to a paucity of readily available data. In this article, we estimate the association between litigation and nursing home exit (closure or change in ownership), separating the impact of malpractice environment from direct litigation. We use 2 main data sources for this study: Westlaw's Adverse Filings database (1997-2005) and Online Survey, Certification and Reporting data sets (1997-2005). We use probit models with state and year fixed effects to examine the relationship between litigation and the probability of nursing home closure or change in ownership with and without adjustment for malpractice environment. We examine the relationship on average and also stratify by profit status, chain membership, and market competition. We find that direct litigation against a nursing home has a nonsignificant effect on the probability of closure or change in ownership within the subsequent 2 years. In contrast, the broader malpractice environment has a significant effect on change in ownership, even for nursing homes that have not been sued, but not on closure. Effects are stronger among for-profit and chain facilities and those in more competitive markets. A high-risk malpractice environment is associated with change of ownership of nursing homes regardless of whether they have been directly sued, indicating that it is too blunt an instrument for weeding out low-quality nursing homes.
对医疗事故诉讼的一个持续担忧是，它可能导致医疗服务提供者退出，从而可能影响消费者福利。疗养院行业面临大量诉讼活动，但就诉讼的影响而言，该行业总体上仍未得到充分研究，这可能是由于缺乏现成的数据。在本文中，我们估计了诉讼与疗养院退出（关闭或所有权变更）之间的关联，将医疗事故环境的影响与直接诉讼区分开来。我们使用了两个主要数据源进行这项研究：汤森路透的《不利档案》数据库（1997 - 2005年）和在线调查、认证与报告数据集（1997 - 2005年）。我们使用带有州和年份固定效应的概率单位模型，来检验诉讼与疗养院关闭或所有权变更概率之间的关系，同时考虑和不考虑医疗事故环境的调整情况。我们考察了平均关系，并按盈利状况、连锁会员关系和市场竞争进行分层。我们发现，对疗养院的直接诉讼对其在随后两年内关闭或所有权变更的概率没有显著影响。相比之下，更广泛的医疗事故环境对所有权变更有显著影响，即使对于未被起诉的疗养院也是如此，但对关闭没有影响。在营利性和连锁设施以及处于竞争更激烈市场的设施中，影响更强。高风险的医疗事故环境与疗养院所有权变更相关，无论它们是否被直接起诉，这表明它作为淘汰低质量疗养院的手段过于简单粗暴。
