The Impact of Exempting Medical Providers from Malpractice Protection

 描述（由申请人提供）：美国医疗保健系统最具争议的方面之一是医疗事故系统对患者治疗和医疗保健费用的影响。军事卫生系统（MHS）下的医疗事故保护结构提供了一个新的机会，以了解医疗事故压力的存在如何导致“防御性医疗”。MHS提供了以前研究中所缺少的：一个真正的“治疗组”，病人的医生没有面临医疗事故的压力。根据联邦法律，在军事设施治疗现役军人患者的现役医生不能因医疗事故而被起诉。然而，医疗事故法确实适用于他们对在这些设施接受治疗的家属和退休人员的治疗。同样，医疗事故法适用于医生治疗 军事设施外的现役军人患者。通过比较患者的医生没有受到“防御性医疗”的压力，其他可比的患者（甚至可能由同一名医生治疗）的医生受到这种压力，我们可以确定防御性医疗压力的影响实践模式，医疗成本和患者的结果。我们的研究目标的核心是提供可能是有史以来用于解决这些问题的最丰富的数据。多年来，MHS为我们提供了一套完整的现役人员、家属和退休人员的医疗和结果记录。这一庞大的数据集包括通常基于索赔的利用率数据指标，以及患者等待时间、患者满意度、死亡率和生物特征结果等指标。我们使用这些数据来解决四个目标：·在心脏护理或产科等“医疗事故敏感”治疗事件中，MHS医疗事故豁免对治疗的影响是什么？ ·医疗事故豁免如何影响总医疗支出？ ·医疗事故豁免如何影响所提供的护理质量？ ·通过医生风格，受保护和未受保护的患者之间是否存在溢出效应？我们将通过对具有医疗事故法差异保护的可比患者进行“差异中的差异”比较，以及通过因果回归模型来实现这些目标，该模型利用了诸如关于谁必须在军事设施接受治疗的基于距离的规则以及医疗事故保护的变化等特征。医生和患者。

 DESCRIPTION (provided by applicant): Among the most controversial aspects of the U.S. health care system are the impacts of the medical malpractice system on patient treatments and health care costs. The structure of malpractice protections under the Military Health System (MHS) provides a novel opportunity to understand how the presence of malpractice pressure leads to "defensive medicine." The MHS provides what is missing in previous studies: a true "treatment group" of patients whose physicians face no malpractice pressure. Under federal law, active duty physicians who treat active duty military patients at military facilities cannot be sue for malpractice. However, malpractice laws do apply to their treatment of dependents and retirees treated at these same facilities. Similarly, malpractice laws apply to physicians treating active duty military patients outside military facilities. By comparing patients whose physicians are not subject to "defensive medicine" pressure to other comparable patients (perhaps even treated by the same physician) whose physicians are subject to such pressure, we can identify the impact of defensive medicine pressure on practice patterns, medical costs, and patient outcomes. Central to our research aims is the availability of perhaps the richest data ever used to address these issues. The MHS has provided us with a complete set of records on medical treatment and outcomes for the entire universe of active duty personnel, dependents, and retirees, over a number of years. This enormous set of data includes usual claims-based measures of utilization data, as well as measures such as patient wait times, patient satisfaction, mortality, and biometric outcomes. We use these data to address four aims: • What is the impact of the MHS malpractice exemption on treatment during "malpractice sensitive" episodes of treatment such as cardiac care or obstetrics? • How does the malpractice exemption impact total medical spending? • How does the malpractice exemption impact the quality of care delivered? • Are there spillovers across protected and unprotected patients through physician styles? We will address these aims both through "difference-in-differences" comparisons of comparable patients with differential protection from malpractice laws, and through causal regression models that exploit features such as distance-based rules on who must be treated at military facilities and changes in malpractice protection across physicians and patients.