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

在过去的二十年里，美国大部分州都采取了各种形式的侵权改革，通常限制非经济损害赔偿和/或惩罚性损害赔偿，修改普通法连带责任规则，和/或修改旁系来源规则。 该项目将研究这些侵权法改革对美国出生率的影响。从1986年到2005年，国家生命统计系统的数百万例出生数据将用于确定侵权法改革是否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被用来确定诉讼的数量或结果是否有任何变化。这项研究为现有的关于侵权改革的文献提供了一些贡献。 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）使用侵权改革的概括性措施表明，这些改革与老年心脏病发作患者的手术数量减少有关，死亡或并发症的数量没有明显增加。然而，没有证据表明对该组以外的手术使用或健康结局有影响。 婴儿是一个非常重要的研究群体，由于每年约有400万婴儿出生，即使是程序使用或结果的微小变化也可能产生重大影响。 本研究通过研究这一重要群体，告知我们对侵权改革健康影响的认识。 其次，之前的许多研究只研究一两种类型的侵权行为改革（通常是上限）或使用汇总措施。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效果。 此外，还研究了使用连续的上限措施，而不是仅仅依靠零一指标。 第三，侵权改革可能会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比对其他病人更关心。 本研究分别针对不同的人口群体，检视侵权改革的效果。 此外，还可以事先确定哪些妇女处于负面结果的高风险中，并确定侵权改革影响这些群体待遇的方式。更广泛的影响：这项研究将为正在进行的关于侵权改革的辩论提供信息，以及联邦在这一领域进行干预的必要性。 审查不同类型的侵权行为改革的效果将特别有用，因为其中一些改革可能以比其他改革更低的成本实现改革的目标。 此外，一些改革可能比其他改革产生更公平的影响。 这项工作将有助于文献的方式，医生对激励措施的反应，以及更广泛的婴儿健康结果的决定因素。 最后，这个项目将有助于培养研究生谁将是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.