Medical Malpractice, Health Care Costs, and Technology Adoption

描述（由申请人提供）：研究和政策团体的成员指出，医疗事故成本的上升是过去10到15年医疗成本增长的主要驱动因素。然而，大多数关于医疗事故的现有研究未能估计其对总体成本的影响，并且依赖于最近受到质疑的经验识别策略。为了填补这一空白，我们建议通过制定新的实证策略来研究医疗事故风险的影响。具体来说，我们建议依靠陪审团倾向的变化来授予高额的“痛苦和折磨”赔偿，以及这些变化对医疗事故成本的影响。我们提出了一系列直接和间接的经验证据，支持这一识别策略的力量和有效性。例如，非经济损失的变化可以显著预测未来的医疗费用，但反之则不然。我们建议将县级陪审团裁决的信息与以下数据联系起来：医疗保险索赔数据、来自全国住院患者样本（NIS）的住院患者入院数据、来自医疗保险当前受益人调查（MCBS）的个人层面数据、来自美国医院协会（AHA）成员医院数据库的医院层面数据以及关于医疗保险成本的县级数据。这些数据来源将使我们能够研究：(1)医疗事故风险的净社会效益，就其对医疗成本和健康的影响而言；(2)医疗事故风险对长期技术采用的影响；(3)医疗事故影响的机制，特别是对医疗产出的影响，以及医疗服务的性质和强度。这项研究为有关侵权改革和医疗事故改革的公共政策提供了信息，这两者都对公共卫生以及私营和公共部门的医疗支出产生了相当大的影响。公共卫生相关性：关于医疗事故制度是否以及如何影响医疗费用和医疗服务提供存在大量争议。我们将探讨医疗事故制度的净社会效益，以及医疗事故风险对医疗成本、健康结果、医疗产出和强度以及新医疗技术采用的因果影响。

DESCRIPTION (provided by applicant): Members of the research and policy communities have pointed to rising malpractice costs as a key driver of medical cost growth over the last ten to fifteen years. However, most of the existing research on malpractice fails to estimate its impact on overall costs, and relies on empirical identification strategies that have recently been called into question. To fill this gap, we propose to study the impacts of malpractice risk by developing a new empirical strategy. Specifically, we propose to rely on changes in the propensities of juries to award high "pain and suffering" awards, and the effect these changes have on malpractice costs. We present an array of direct and indirect empirical evidence in favor of both the power and validity of this identification strategy. For example, variation in non-economic damages significantly predicts future medical costs, but the reverse is not true. We propose to link information on county-level jury verdicts to: data on Medicare claims, inpatient hospital admissions data from the National Inpatient Sample (NIS), individual-level data from the Medicare Current Beneficiary Survey (MCBS), hospital-level data from the American Hospital Association (AHA) database of member hospitals, and county-level data on Medicare costs. These data sources will allow us to study: (1) The net social benefits of malpractice risk, in terms of its impacts on medical costs and health; (2) The impact of malpractice risk on long-run technology adoption; and (3) The mechanisms underlying the impacts of malpractice, particularly its impacts on the medical output, along with the nature and intensity of medical care. This research informs public policy regarding tort reform and malpractice reform, both of which have considerable impacts on public health, along with medical spending in the private and public sector. PUBLIC HEALTH RELEVANCE: There is an enormous amount of controversy over whether and how the malpractice system affects medical costs and health care delivery. We will explore the net social benefits of the malpractice regime, along with the causal impact of malpractice risk on medical costs, health outcomes, medical output and intensity, and the adoption of new medical technologies.