EFFECT OF MEDICAL MALPRACTICE ON COSTS & TECH ADOPTION

描述（由申请人提供）：许多观察家认为，医疗事故成本的增长不必要地抬高了医疗成本，或阻碍了新技术的采用。评估这个陈述是困难的，因为因果关系是复杂的。医疗事故风险会增加行医成本，但更高的医疗成本会提高解决医疗事故索赔的成本，这涉及到大量的医疗支出。采用新技术的问题同样复杂，因为采用新技术会增加医疗差错和医疗事故的风险。对技术的影响也可能随着技术的年龄而不同：不当操作可能会鼓励采用经过验证的技术，而不鼓励采用未经验证的技术。为了澄清这些问题，我们建议调查医疗事故、医疗费用和医疗技术之间的因果关系。为了从经验上确定医疗事故与医疗成本的关系，我们确定了一个影响医疗成本但不影响医疗事故成本（至少不直接）的因素，以及一个影响医疗事故成本但不影响医疗成本（直接）的因素。首先，我们将使用县级非医疗事故医疗费用作为单独影响医疗费用的工具；我们的衡量基于医疗保险的非医疗事故医疗成本指数，包括诸如医生等熟练工人的相对工资、护士的相对工资、办公空间、用品等因素。其次，我们将使用陪审团慷慨程度的县级差异作为影响医疗事故和解的因素，但不包括医疗费用；这是使用RAND陪审团裁决数据库中关于“痛苦和折磨”奖项的县级数据来衡量的。我们建议对医疗事故和医疗技术采取类似的方法。我们将把陪审团慷慨程度的变化单独作为影响医疗事故和解的一个因素。最后，我们将把产科的医疗事故成本作为一个与外科医生面临的医疗事故风险相关的因素，而不是与他们选择用于治疗心脏病患者的技术相关的因素。

DESCRIPTION (provided by applicant): Many observers have argued that the growth of malpractice costs has unnecessarily inflated the cost of medical care, or stunted the adoption of new technology. Evaluating this statement is difficult, because the causality is complex. Malpractice risk can increase the cost of practicing medicine, but higher medical costs can raise the cost of settling malpractice claims, which involve a substantial medical expenditure component. The technology-adoption question is equally complex, since the adoption of new technologies can increase medical errors and malpractice risk. The effect on technology might also differ with the age of the technology: malpractice might encourage the adoption of proven technologies, while discouraging the adoption of unproven ones. To help clarify these issues, we propose to investigate the causal links among malpractice, medical costs, and medical technology. To identify the malpractice-medical cost relationship empirically, we identify a factor that affects medical costs but not malpractice costs (at least not directly), and one that affects malpractice costs but not medical costs (directly). First, we will use a county-level measure of non-malpractice medical costs as an instrument that affects medical costs alone; our measure, based on Medicare's non-malpractice medical costs index, includes such factors as the relative pay of skilled workers like physicians, the relative pay of nurses, office space, supplies, etc. Second, we will use county-level variation in jury generosity as a factor influencing malpractice settlements, but not medical costs; this is measured using county-level data from the RAND Jury Verdicts Database on "pain and suffering" awards. We propose a similar approach to malpractice and medical technology. We will use variation in jury generosity as a factor influencing malpractice settlements alone. Finally, we will rely on malpractice costs in obstetrics as a factor correlated with malpractice risk faced by surgeons, but not with the technologies they choose to use to treat heart patients.