Malpractice experience and the incidence of cesarean delivery: a physician-level longitudinal analysis.

This study examines the influence of malpractice claims on the practice behavior of a panel of obstetricians in Florida during the period 1992-1995 to determine whether physicians respond to malpractice events by performing more cesareans, consistent with the notion that cesarean sections are employed as "defensive medicine." Findings indicate that clinical events resulting in claims that lead to substantial indemnity payments have a significant, modest effect on physician practice behavior: physicians experiencing those claims increase their risk-adjusted cesarean rates by about one percentage point. Malpractice experience does not appear to affect patient mix, but claims with large payouts may affect patient volume.

Evaluating the tobacco settlement damage awards: too much or not enough?

OBJECTIVES: This study compared the present economic value of the 1998 tobacco settlement with the present economic value of the damages attributable to tobacco. METHODS: The 1987 National Medical Expenditure Survey was used to estimate the smoking attributable fraction (SAF) of medical expenditures. SAFs were then applied to Medicaid and other expenditures. RESULTS: Settlement payments covered only 40% of Medicaid treatment costs already incurred and only 30% of past and projected future Medicaid costs. Excess medical expenditures for all other payment sources were roughly comparable to those incurred by Medicaid. CONCLUSIONS: Although the settlement may reduce future smoking prevalence rates by limiting the ability of tobacco companies to promote smoking and by raising cigarette prices, euphoria over the huge settlement funds should be balanced by a sober comparison with the even larger damage amounts.