Penny B. Githens

Effects of the threat of medical malpractice litigation and other factors on birth outcomes.

Most major health reform proposals include reform of medical malpractice. A major objective of the current medical malpractice system is to improve quality of care. The authors examine the effect of variations in the threat of medical malpractice, measured by claims frequency and payments per exposure year, on various indicators of birth outcomes, fetal deaths, low Apgar score, death within 5 days of birth, infant death, and death or permanent impairment at 5 years of age. Data came from 2 sources: a Survey of Obstetrical Care of 963 women in Florida in 1992 who delivered 5 years previously; and a fetal death and a linked birth-death file obtained from Florida Vital Statistics for 1987. Among the outcomes considered, only fetal deaths decreased in response to an increased threat of being sued, and this relationship was only obtained from one of the data sets. Overall, no systematic improvement in birth outcomes in response to an increased threat of medical malpractice litigation was obtained.

Drinking, Driving, and the Price of Automobile Insurance

This study describes premium penalties imposed by insurers for drunk driving and other chargeable accidents, assesses why variations in premiums for drivers with clean records and adverse records differ across states and insurers, and determines the effect of imposing penalties on persons convicted of drunk driving. There are significant differences among insurers in treatment of violators, both in underwriting and in premium setting-which are in part attributable to state policies, such as imposition of take-all-comer rules. Imposing premium surcharges for a charge of drunk driving has a significant deterrent effect on the probability of drinking and driving.

Malpractice, Patient Satisfaction, and Physician-Patient Communication-Reply

In Reply. —The Fallon Clinics experience is encouraging and suggests that it is possible to enhance patient perceptions of the interpersonal skills of physicians, perhaps even those with high malpractice claims experience. One possible explanation is that the process of obtaining feedback from peers led the clinicians to appreciate the problems so that they could address them. Another is that the training program actually imparted new skill. Understanding the relative importance of peer-provided feedback and providing physicians education concerning the skill to correct identified problems is needed in order to design education strategies that sustain behavioral changes over time. Dr Weyrauchs hypotheses are important, and we would argue that all the interpersonal skills in the world will not heal a physician-patient relationship marred by bias and condescension. Nonetheless, to the extent we looked, we did not find evidence that patients were more likely to see the high-frequency physicians as biased