Dy Christopher J, Pesko Michael F, Keller Matthew, Sepper Elizabeth, Olsen Margaret A
1Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St Louis, MO 63110 USA.
2Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO USA.
HSS J. 2020 Feb;16(1):54-61. doi: 10.1007/s11420-018-9650-4. Epub 2019 Jan 3.
Supporters of medical liability reform contend that caps on non-economic damages will decrease defensive medicine.
QUESTIONS/PURPOSES: We examined whether removal of caps on non-economic damages affect one type of defensive medical practice, early imaging for new-onset low back pain.
Using administrative claims data, we retrospectively studied adult patients evaluated for new-onset low back pain from 2007 to 2012. We included patients from two states that had caps on non-economic damages struck down in 2010 ( = 462,604) and patients from adjacent states ( = 781,963). Using a difference-in-differences approach, we evaluated the impact of non-economic damage caps on early imaging while adjusting for physician specialty, patient characteristics, and year- and state-level fixed effects.
There was no association between non-economic damage caps and early imaging for low back pain among all providers. Removal of a non-economic damage cap was also not associated with a significant change in early imaging within the two cap-removal states. Subgroup analysis by physician specialty demonstrated significantly increased use of early imaging for low back pain by orthopedic or neurological surgeons in the first 12 months following cap removal in one state (but this difference did not persist beyond 12 months). In the other cap-removal state, early imaging increased among orthopedic and neurological surgeons more than 12 months after cap removal.
We found no association between caps on non-economic damages and early imaging for low back pain among all physicians. However, our subgroup analysis suggests that physician specialties may respond to non-economic damage cap policies differently.
医疗责任改革的支持者认为，对非经济损害赔偿设置上限将减少防御性医疗行为。
问题/目的：我们研究了取消非经济损害赔偿上限是否会影响一种防御性医疗行为，即新发腰痛的早期影像学检查。
利用行政索赔数据，我们回顾性研究了2007年至2012年因新发腰痛接受评估的成年患者。我们纳入了来自两个州的患者（n = 462,604），这两个州在2010年取消了非经济损害赔偿上限，以及来自相邻州的患者（n = 781,963）。采用差异中的差异方法，我们在调整医生专业、患者特征以及年份和州层面的固定效应后，评估了非经济损害赔偿上限对早期影像学检查的影响。
在所有医疗服务提供者中，非经济损害赔偿上限与腰痛的早期影像学检查之间没有关联。取消非经济损害赔偿上限在两个取消上限的州内也与早期影像学检查的显著变化无关。按医生专业进行的亚组分析表明，在一个州取消上限后的前12个月内，骨科或神经外科医生对腰痛进行早期影像学检查的使用率显著增加（但这种差异在12个月后并未持续）。在另一个取消上限的州，取消上限12个月后，骨科和神经外科医生的早期影像学检查增加。
我们发现所有医生中非经济损害赔偿上限与腰痛的早期影像学检查之间没有关联。然而，我们的亚组分析表明，医生专业对非经济损害赔偿上限政策的反应可能不同。
