Essays on malpractice law and physician behavior

This dissertation contributes to an understanding of the manner in which various dimensions of malpractice law shape physician behavior and how this behavior, in turn, impacts health outcomes. In Chapter 1, I explore the association between regional variations in physician practices and the geographical scope of the standards of care to which physicians are held in malpractice actions. To investigate this general association, I explore whether treatment utilization rates in a state converge towards national utilization levels as states abandon the use of "locality rules" to adopt laws requiring physicians to comply with national standards of care. I focus the analysis on the case of cesarean delivery and find robust evidence of convergence in cesarean section utilization, whereby as much as 40 - 60% of the gap between state and national cesarean rates is closed upon the abandonment of a locality rule. In Chapter 2, I estimate the returns to regional cesarean intensities, drawing on an arguably exogenous source of variation in cesarean rates resulting from the adoption of national-standard laws. I first document robust evidence of triage in regional cesarean utilization, whereby physicians in high intensity regions begin to perform cesareans on mothers who are less in need of this intensive delivery alternative. Second, I find no evidence to suggest that an increase in regional cesarean rates otherwise leads to an increase in average neonatal outcomes.

Department dc:contributor.department

Massachusetts Institute of Technology. Dept. of Economics.

Grantor dc:publisher

Massachusetts Institute of Technology

Year dc:date.issued

2009

Author dc:creator

• Frakes, Michael (Michael D.)

Advisor dc:contributor.advisor

• Jonathan Gruber and Amy Finkelstein.

• Economics.

Statement dc:rights

• M.I.T. theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. See provided URL for inquiries about permission.

Licence dc:rights.uri

• http://dspace.mit.edu/handle/1721.1/7582

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/1721.1/49706

OAI identifier oai:identifier

oai:dspace.mit.edu:1721.1/49706