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

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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.