First Do No Harm? The Effects of Tort Reform on Outcomes and Procedures at Birth.

在过去的二十年里，美国大多数州都采取了各种形式的侵权法改革，通常是限制非经济损害赔偿和/或惩罚性损害赔偿，修改普通法的连带责任规则，和/或修改附带来源规则。该项目将研究这些侵权改革对美国出生的影响。从1986年到2005年，来自国家生命统计系统的数百万个人出生的数据将被用来确定侵权改革是否会影响各种类型的程序和婴儿的健康结果。一个关于医疗事故赔偿的国家数据集也将用于确定诉讼数量或结果是否有任何变化。本研究为侵权改革的现有文献提供了许多贡献。首先，以前很少有关于侵权改革对健康结果影响的研究。在一篇著名的论文中，Kessler和McClellan（1996）使用侵权改革的总结措施表明，这些改革与老年心脏病患者的手术数量减少有关，而死亡或并发症的数量没有明显增加。然而，在这一群体之外，没有证据表明对手术使用或健康结果有影响。婴儿是一个非常重要的研究群体，由于每年大约有400万新生儿，即使是程序使用或结果的微小变化也可能产生巨大的影响。本研究通过研究这一重要群体，使我们了解了侵权改革对健康的影响。其次，许多先前的研究只考察了一种或两种类型的侵权改革（通常是上限）或使用总结措施。本研究发展了不同类型侵权改革的理论含义，并考察了这些不同改革的单独影响。此外，使用连续措施的上限，而不是仅仅依赖于0 - 1指标进行了调查。第三，侵权法改革可能对不同的群体产生不同的影响，因为它鼓励医生对某些病人给予更多的照顾。本研究分别考察了侵权改革对不同人口群体的影响。此外，有可能先验地识别出具有较高负面结果风险的妇女，并确定侵权法改革影响这些群体治疗的方式。更广泛的影响：本研究将告知正在进行的辩论侵权改革，并在这一领域的联邦干预的可取性。审查不同类型的侵权法改革的效果将特别有用，因为其中一些改革可能比其他改革以更低的成本实现改革目标。此外，一些改革可能比其他改革产生更公平的影响。这项工作将有助于研究医生对激励措施的反应方式，以及婴儿健康结果的更广泛决定因素。最后，这个项目将有助于培养研究生，他们将成为项目的一个组成部分。

Over the past twenty years, most U.S. states have adopted various forms of tort reform, often capping non-economic damages and/or punitive damages, amending the common-law joint-and-several liability rule, and/or amending the collateral source rule. This project will examine the impact of these tort reforms on births in the U.S. Data on millions of individual births from 1986 to 2005 from the national vital statistics system will be used to determine whether tort reform affects various types of procedures that are performed and the health outcomes of infants. A national data set on medical malpractice awards will also be used to determine whether there are any changes in the number or outcomes of lawsuits.This study offers a number of contributions to the existing literature on tort reform. First, there is very little previous research on the effects of tort reform on health outcomes. In a famous paper, Kessler and McClellan (1996) show using summary measures of tort reform that these reforms were associated with decreases in the number of procedures performed on elderly heart attack patients, with no apparent increase in the number of deaths or complications. There is however, no evidence of effects on procedure use or health outcomes outside this group. Infants are a very important group to study, and since there are approximately four million births each year, even small changes in procedure use or outcomes may have large consequences. This study informs our knowledge of the health effects of tort reform by studying this important group. Second, many previous studies examine only one or two types of tort reform (usually caps) or use a summary measure. This study develops the theoretical implications of different types of tort reforms and examines the separate effects of these different reforms. In addition, the use of continuous measures of caps rather than relying solely on zero-one indicators is investigated. Third, tort reform may have different effects on different groups by encouraging doctors to take more care with some patients than with others. This study examines the effects of tort reform separately for different demographic groups. Also, it is possible to identify women who are at high risk of negative outcomes a priori, and the way that tort reform affects treatment of these groups is determined.Broader Impacts: This research will inform the ongoing debate over tort reform, and the desirability of federal intervention in this area. It will be particularly useful to examine the effects of different types of tort reforms, as some of them may achieve the goals of reform at less cost than others. Also, some reforms may have more equitable impacts than others. This work will contribute to the literature on the way that doctors respond to incentives, and about the broader determinants of infant health outcomes. Finally, this project will help to train the graduate student who will be an integral part of the project.