|Titel:||Medical Malpractice in Public Healthcare Systems: An empirical investigation of scheduled damages||Sprache:||Englisch||Autor*in:||Bertoli, Paola||Schlagwörter:||Medical malpractice; Scheduled damages; Medical liability insurance; Judicial inefficiency; Public healthcare system||Erscheinungsdatum:||2014||Tag der mündlichen Prüfung:||2014-06-30||Zusammenfassung:||
In the last decades, medical malpractice has been framed as one of the most critical issues for healthcare providers and health policy, holding a central role on both the policy agenda and public debate. Given the variety and complexity of the effects produced by this phenomenon, a wide range of policy interventions has been proposed to cope with it. The Law and Economics literature has devoted much attention to medical malpractice and to the investigation of the actual impact of malpractice reforms. Nonetheless, some types of cap have been much less empirically studied as in the case of schedules of noneconomic damages, and their effects remain highly debated. Moreover, the need for further research in this field is even more apparent in Europe, where this strand of the literature is less developed than in the U.S. and both the legal and healthcare systems have remarkable specificities that make it difficult to straightforwardly extend the conclusions drawn from the American context. The present work seeks to contribute to the study of medical malpractice and of schedules of noneconomic damages in a civil law country with a public national health system, using Italy as case study, and at offering an evaluation of the policy implications of this investigation. Besides considering schedules and exploiting a quasi-experimental setting, the novelty of our contribution consists in the inclusion of the performance of the judiciary (measured as courts' civil backlog) in the empirical analysis. Traditionally, malpractice reforms have been analyzed regardless of the performance of their enforcement mechanism. Differently, our expectation is that the functioning of the judiciary alone is capable of influencing the main players of the malpractice system (i.e. physicians, victims and insurers), thus to condition the impact of schedules.
The empirical analysis is twofold. First, it investigates how limiting compensations for pain and suffering through schedules impacts on the malpractice insurance market both in terms of presence of private insurers in the market and of premiums applied. In other words, the first purpose of the empirical analysis is to verify whether and to what extent schedules are actually effective in achieving their expected results. Second, it examines whether, and to what extent, healthcare providers react to the implementation of this policy in terms of both levels and composition of the medical treatments offered. In this case, the main purpose is to provide additional insights on the functioning of schedules, improving the understanding of those effects that go beyond the primary scope of schedules.
Our findings show that the introduction of schedules increases the presence of insurers only in inefficient courts, while it does not produce significant effects on paid premiums. Judicial inefficiency is attractive to insurers for average values of schedules penetration of the market, with an increasing positive impact of inefficiency as the territorial coverage of schedules increases. Moreover, the implementation of schedules tends to reduce the use of defensive practices on the part of clinicians, but the magnitude of this impact is ultimately determined by the actual degree of backlog of the court implementing schedules.
Lippi Bruni, Matteo
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geprüft am 03.03.2021
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