The Impact of State Medical Malpractice Reform on Individual-Level Health Care Expenditures.
The Impact of State Medical Malpractice Reform on Individual-Level Health Care Expenditures.
复制标题
国家医疗事故改革对个人医疗保健支出的影响。
DOI：
10.1111/1475-6773.12789
复制
发表时间：
2017
影响因子：
3.4
通讯作者：
Haviland,Amelia
中科院分区：
文献类型：
--
作者：
Yu,Hao;Greenberg,Michael;Haviland,Amelia
背景过去关于州一级医疗事故改革对卫生支出影响的研究得出了不同的结果。特别突出的是，关于不同类型的医疗事故改革效果的证据差距。本研究旨在填补这一差距。它通过检查一般人群，而不是一个亚组或一个特定的健康状况，并控制个人层面的社会人口和健康状况，扩展了文献。MethodsWe合并了1996年和2012年之间的医疗支出面板调查数据库的国家侵权法改革。我们采用差异中差异的方法来指定一个两部分模型来分析个人层面的医疗支出。我们应用循环预测方法和自助技术来检验有改革和没有改革的州之间的卫生支出增长差异。所有支出转换为2010年美元。结果只有两个10个主要的国家级医疗事故的改革有显着的影响，个人层面的卫生支出的增长。实行律师意外事故费上限的州的平均年支出增加幅度小于未实行改革的州（p< .05）。与实行传统过失相抵制度的州相比，实行纯过失改革的州的平均年支出增加更多（p< .05），并规定如果原告的过错等于或大于被告的过错，则禁止进行相对过错改革（p< .05）。结论一些州一级的医疗事故改革显著影响了个人一级卫生支出的增长，影响的方向和程度因改革类型而异。
BackgroundPast studies of the impact of state‐level medical malpractice reforms on health spending produced mixed findings. Particularly salient is the evidence gap concerning the effect of different types of malpractice reform. This study aims to fill the gap. It extends the literature by examining the general population, not a subgroup or a specific health condition, and controlling for individual‐level sociodemographic and health status.MethodsWe merged the Database of State Tort Law Reforms with the Medical Expenditure Panel Survey between 1996 and 2012. We took a difference‐in‐differences approach to specify a two‐part model for analyzing individual‐level health spending. We applied the recycled prediction method and the bootstrapping technique to examining the difference in health spending growth between states with and without a reform. All expenditures were converted to 2010 U.S. dollars.ResultsOnly two of the 10 major state‐level malpractice reforms had significant impacts on the growth of individual‐level health expenditures. The average annual expenditures in states with caps on attorney contingency fees increased less than that in states without the reform (p< .05). Compared with states with traditional contributory negligence rule, the average annual expenditures increased more in both states with a pure comparative fault reform (p< .05) and states with a comparative fault reform that barred recovery if the plaintiff's fault was equal to or greater than the defendant's (p< .05).ConclusionsA few state‐level malpractice reforms had significantly affected the growth of individual‐level health spending, and the direction and magnitude of the effects differed by type of reform.