Download PDF
Am J Perinatol 2019; 36(07): 723-729
DOI: 10.1055/s-0038-1675156
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Increasing Malpractice Insurance Cost and Subsequent Practice of Defensive Medicine on Out-of-Hospital Birth Rates in the United States

Edward Kangsuhp Kim
1   Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
William James Fletcher
2   Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
,
Clark Timothy Johnson
1   Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

11 November 2017

03 September 2018

Publication Date:
29 October 2018 (online)

    Permissions and Reprints

Abstract

Background Across the United States, the burden of malpractice litigation has influenced obstetricians and obstetric institutions to avoid high-risk patients, favor cesarean delivery, and decrease availability of trial of labor after cesarean. Recently, the United States has experienced an increase in out-of-hospital (OOH) births.

Objective The main purpose of this article is to investigate the association between malpractice insurance premium (MIP) and OOH births in the United States from 2000 to 2014.

Study Design We analyzed changes in OOH birth rates and MIP from 2000 to 2014 using birth data from the National Vital Statistics System and Medical Liability Monitor's annual survey, respectively. The change in OOH birth rates was then compared with the change in MIP.

Results Between 2000 and 2014, there has been approximately 60% increase in MIP from national average of $40,949 to $65,210 (p < 0.05). OOH births increased 57% from 39,398 births to 59,674 births (p < 0.05). There was a significant positive correlation between increase in MIP and increase in OOH births (p < 0.05, R 2 = 0.14).

Conclusion MIP and OOH birth rates have a significantly associated increase from 2000 to 2014. Given that malpractice climate affects other aspects of obstetric practice, we cautiously propose that increasing MIP may be associated with an increase in OOH births.

Keywords

malpractice - out-of-hospital birth - defensive medicine - United States - litigation
 

  • References

  • 1 Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med 2011; 365 (07) 629-636
    CrossrefPubMedGoogle Scholar
  • 2 Hale RW. Legal issues impacting women's access to care in the United States—the malpractice insurance crisis. Int J Gynaecol Obstet 2006; 94 (03) 382-385
    CrossrefPubMedGoogle Scholar
  • 3 Mello MM, Studdert DM, Schumi J, Brennan TA, Sage WM. Changes in physician supply and scope of practice during a malpractice crisis: evidence from Pennsylvania. Health Aff (Millwood) 2007; 26 (03) w425-w435
    CrossrefPubMedGoogle Scholar
  • 4 Studdert DM, Mello MM, Sage WM. , et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 2005; 293 (21) 2609-2617
    CrossrefPubMedGoogle Scholar
  • 5 Carpentieri A, Lumalcuri J, Shaw J. Overview of the 2015 American Congress of Obstetricians and Gynecologists' Survey on Professional Liability. Washington, D.C.: ACOG; 2015
    Google Scholar
  • 6 Agency for Healthcare Research and Quality. Vaginal Birth after Cesarean: New Insights. Rockville, MD: Agency for Healthcare Research and Quality; 2010
    Google Scholar
  • 7 National Institutes of Health Consensus Development Conference Panel. National Institutes of Health Consensus Development conference statement: vaginal birth after cesarean: new insights March 8-10, 2010. Obstet Gynecol 2010; 115 (06) 1279-1295
    CrossrefPubMedGoogle Scholar
  • 8 Wells CE. Vaginal birth after cesarean delivery: views from the private practitioner. Semin Perinatol 2010; 34 (05) 345-350
    CrossrefPubMedGoogle Scholar
  • 9 Johnson C, Choubey V, Satin A, Werner EF. Malpractice and obstetric practice: the correlation of malpractice premiums to rates of vaginal and cesarean delivery. Am J Obstet Gynecol 2016; 214 (05) 545-546
    CrossrefPubMedGoogle Scholar
  • 10 Zwecker P, Azoulay L, Abenhaim HA. Effect of fear of litigation on obstetric care: a nationwide analysis on obstetric practice. Am J Perinatol 2011; 28 (04) 277-284
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Polsky D, Marcus SC, Werner RM. Malpractice premiums and the supply of obstetricians. Inquiry: The Journal of Health Care Organizations, Provision, and Financing 2010; 47 (01) 48-61
    PubMedGoogle Scholar
  • 12 Gregory KD, Fridman M, Korst L. Trends and patterns of vaginal birth after cesarean availability in the United States. Semin Perinatol 2010; 34 (04) 237-243
    CrossrefPubMedGoogle Scholar
  • 13 Roberts RG, Deutchman M, King VJ, Fryer GE, Miyoshi TJ. Changing policies on vaginal birth after cesarean: impact on access. Birth 2007; 34 (04) 316-322
    CrossrefPubMedGoogle Scholar
  • 14 Macdorman MF, Declercq E, Mathews TJ, Stotland N. Trends and characteristics of home vaginal birth after cesarean delivery in the United States and selected States. Obstet Gynecol 2012; 119 (04) 737-744
    CrossrefPubMedGoogle Scholar
  • 15 Dahlen HG, Jackson M, Stevens J. Homebirth, freebirth and doulas: casualty and consequences of a broken maternity system. Women Birth 2011; 24 (01) 47-50
    CrossrefPubMedGoogle Scholar
  • 16 Hazen H. “The First Intervention Is Leaving Home”: reasons for electing an out-of-hospital birth among Minnesotan mothers. Med Anthropol Q 2017; 31 (04) 555-571
    CrossrefPubMedGoogle Scholar
  • 17 Jackson M, Dahlen H, Schmied V. Birthing outside the system: perceptions of risk amongst Australian women who have freebirths and high risk homebirths. Midwifery 2012; 28 (05) 561-567
    CrossrefPubMedGoogle Scholar
  • 18 MacDorman MF, Declercq E. Trends and characteristics of United States out-of-hospital births 2004-2014: new information on risk status and access to care. Birth 2016; 43 (02) 116-124
    CrossrefPubMedGoogle Scholar
  • 19 Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol 2010; 203 (03) 243.e1-243.e8
    CrossrefPubMedGoogle Scholar
  • 20 Grünebaum A, McCullough LB, Sapra KJ, Arabin B, Chervenak FA. Planned home births: the need for additional contraindications. Am J Obstet Gynecol 2017; 216 (04) 401.e1-401.e8
    CrossrefPubMedGoogle Scholar
  • 21 Tilden EL, Cheyney M, Guise JM. , et al. Vaginal birth after cesarean: neonatal outcomes and United States birth setting. Am J Obstet Gynecol 2017; 216 (04) 403.e1-403.e8
    CrossrefPubMedGoogle Scholar
  • 22 Snowden JM, Tilden EL, Snyder J, Quigley B, Caughey AB, Cheng YW. Planned out-of-hospital birth and birth outcomes. N Engl J Med 2015; 373 (27) 2642-2653
    CrossrefPubMedGoogle Scholar
  • 23 American College of Obstetricians and Gynecologists. Committee Opinion No 669: Planned Home Births. Washington, D.C.: Obstetrics and Gynecology; 2016
    Google Scholar
  • 24 Center for Disease Control and Prevention. Natality, 2007–2015. Retrieved from CDC WONDER. Available at: https://wonder.cdc.gov/natality-current.html . Accessed September 27, 2018
    PubMedGoogle Scholar
  • 25 Medical Liability Monitor. MLM Quarterly Analysis of the MPL Industry. Brookfield, WI: Medical Liability Monitor; 2014
    Google Scholar