Sofia, AmaralGarcia and Veronica, Grembi (2012): curb your premium! evaluating state intervention in medical malpractice insurance.
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We study a policy aimed at reducing the insurance costs paid by local public healthcare providers. The policy is based on enhanced monitoring of medical malpractice claims by the regional government that rules local providers. In particular, we implement a Difference-in-Differences strategy using Italian data at the provider level from 2001 to 2008 to evaluate the impact of monitoring on medical liability expenditures, measured as insurance premiums and legal expenditures. Our results show that this information-enhancing policy reduces paid premiums. This reduced-form effect might arise by both the higher bargaining power of the demand side or by increased competition on the supply side of the insurance market. Empirical evidence on the post-treatment period supports the competition-channel hypothesis, as the policy reduces the Herfindahl-Hirschman index at the insurance company level by about 30%. Validity tests show that our findings are not driven by differential pre-policy trends between treated and control providers.
|Item Type:||MPRA Paper|
|Original Title:||curb your premium! evaluating state intervention in medical malpractice insurance|
|Keywords:||Medical Errors, Medical Malpractice Premium, Legal Expenditures, Difference in Difference|
|Subjects:||K - Law and Economics > K3 - Other Substantive Areas of Law > K32 - Environmental, Health, and Safety Law
G - Financial Economics > G2 - Financial Institutions and Services > G22 - Insurance; Insurance Companies
I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health
|Depositing User:||Veronica Grembi Grembi|
|Date Deposited:||19. Aug 2012 16:25|
|Last Modified:||12. Feb 2013 21:50|
Acemoglu, D., Cantoni, D., Johnson, S. and Robinson, J. (2011). The Consequences of Radical Reform: The French Revolution, The American Economic Review 101(7): 3286–3307.
AGCM (1997). Affidamento dei servizi assicurativi da parte degli enti pubblici, Technical report, Autorità Garante per la Concorrenza e il Mercato, AS107, Rome.
AGCM (2009). Affidamento del servizio di brokeraggio assicurativo da parte delle pubbliche amministrazioni, AS623 Bollettino 40, Autorita Garante per la Concorrenza e il Mercato.
AGENAS (2009). Rapporto sull’indagine relativa ai sistemi regionali di gestioni sinistri, Agenzia Nazionale per i Servizi Sanitari Regionali.
Amaral-Garcia, S. (2011). Quantifying the Economics of Medical Malpractice: A View from a Civil Law Perspective.
Amaral-Garcia, S. and Grembi, V. (2011). Le Responsabilita nei Servizi Sanitari - Profili Giuridici, Economici, Clinici e Comparatistici, Zanichelli, chapter Economia della Malpractice Medica: Elementi Teorici ed Evidenze Empiriche.
Anessi Pessina, E. (2011). Mobilità e contabilità economica, Convegno di primavera AIES .
Anessi Pessina, E., Cantu, E. and Jommi, C. (2004). Phasing Out Market Mechanisms in the Italian National Health Service, Public Money and Management 24: 309–316.
ANIA (2008). Tutti i numeri del contenzioso medico-legale, Technical report, Associazione Nazionale fra le Imprese Assicuratrici.
ANIA (2010). L’ assicurazione italiana 2009/2010, Technical report, Assicurazione Nazionale fra le Imprese Assicuratrici.
Arrow, K. J. and Lind, R. C. (1970). Uncertainty and the Evaluation of Public Investment Decisions, The American Economic Review 60(3): 364–378.
Autor, D. H., Donohue III, J. and Schwab, S. (2006). The Costs of Wrongful-Discharge Laws, The Review of Economics and Statistics 88(2): 211–231.
Avraham, R. (2011). Database of State Tort Law Reforms (DSTLR 4th), University of Texas Law, Law and Econ Research Paper No. 184 .
Baker, T. (2005b). Medical Malpractice and the Insurance Underwriting Cycle, University of Connecticut School of Law Articles and Working Papers 26-37.
Bertrand, M., Duflo, E. and Mullainathan, S. (2004). How Much Should We Trust Differences-in-Differences Estimates?, Quarterly Journal of Economics 119: 249–275.
Black, B., Hyman, D., Silver, C. and Sage, W. (2005). Stability, Not Crisis: Medical Malpractice Claim Outcomes in Texas, 1988-2002, Journal of Empirical Legal Studies 2(2): 207–259.
Black, B., Hyman, D., Silver, C. and Sage, W. (2008). Defense Costs and Insurer Reserves in Medical Malpractice and Other Personal Injury Cases: Evidence from Texas, 1988-2004, American Law and Economics Review pp. 185–245.
Bordignon, M. and Turati, G. (2009). Bailing out expectations and public health expenditure, Journal of Health Economics 28(2): 305–321.
Buzzacchi, L. and Gracis, C. (2008). Meccanismi allocativi per il rischio sanitario nelle Aziende Sanitarie pubbliche italiane, Mecosan 66: 105–125.
CERGAS-Bocconi (2010). Rapporto OASI 2010 - L’azzendalizzazione della sanità in Italia.
Currie, J. and MacLeod, W. B. (2008). First Do No Harm? Tort Reform and Birth Outcomes, Quarterly Journal of Economics 123(2): 795–830.
Danzon, P., Epstein, A. J. and Johnson, S. J. (2004). Brookings-Wharton Papers on Financial Services, Washington, DC: Brookings Institution Press, chapter The Crisis in Medical Malpractice Insurance, pp. 55–96.
Danzon, P. M. (2000). Liability for Medical Malpractice, Chapter 26 of J. Newhouse and A. Culyer (eds.), Handbook of Health Economics, Elsevier 1: 1339–1404.
Dranove, D. and Wanabe, Y. (2010). Influence and Deterrence: How Obstetricians Respond to Litigation against Themselves and Their Colleagues, American Law and Economics Review 12(1): 69:94.
EOHCS (2001). Health Care Systems in Transition: Italy, European Observatory on Health Care Systems.
Fabbri, D. and Robone, S. (2010). The geography of hospital admission in a National Health Service with Patient Choice, Health Economics 19: 1029–1047.
Fattore, G. (1999). Health Care and Cost Containment in the European Union, Aldershot: Ashgate, chapter Cost-containment and reforms in the Italian National Health Service, pp. 513–546.
Fenn, P., Gray, A. and Rickman, N. (2004). The Econonomics of Clinical Negligence Reform in England, The Economic Journal 114: F272–F292.
Fenn, P., Gray, A., Rickman, N., Vencappa, D., Rivero, O. and Lotti, E. (2010). Enterprise Liability, Risk Pooling, and Diagnostic Care, Journal of Public Administration Research and Theory 20: i225–i242.
Fenn, P., Gray, A., Rickman, N., Vencappa, D., Rivero, O. and Lotti, E. (2012). The Impact of Risk Management Standards on Patient Safety: The Determinants of MRSA Infections in Acute NHS Hospitals, 2001-2008, Oxford Bulletin of Economics and Statistics doi: 10.1111/j.1468-0084.2012.00694.x
Fenn, P., Rickman, N. and Gray, A. (2007). Liability, insurance and medical malpractice, Journal of Health Economics 26: 1057–1070.
Fiorentini, G., Lippi Bruni, M. and Ugolini, C. (2008). Health Systems and Health Reforms in Europe: the Case of Italy, Intereconomics pp. 205–212.
France, G. and Taroni, F. (2005). The Evolution of Health-Policy Making in Italy, Journal of Health Politics, Policy and Law 30 (1-2): 169–187.
France, G., Taroni, F. and Donatini, A. (2005). The Italian health-care system, Health Economics 14: S187–S202.
GAO (2003a). Medical Malpractice. Multiple Factors Have Contributed to Increased Premium Rates, Technical report, GAO-03-702, Washington, DC, US Government Printing Office.
GAO (2003c). Medical Malpractice Insurance. Multiple Factors Have Contributed to Premium Rate Increases Testimony before the Subcommittee on Wellness and Human Rights, Technical report, GAO, Washington DC, US Government Printing Office.
Garoupa, N. and Grembi, V. (2010). Medical Malpractice in Civil Law: Some Evidence From the Italian Court of Cassation, Mimeo .
ISTAT (2009). Conti Economici Regionali. Statistiche 1995-2008, Italian National Institute of Statistics .
Jommi, C., Cantu, E. and Anessi-Pessina, E. (2001). New funding arrangements in the Italian National Health Service, International Journal of Health Planning and Management 16(4): 347–368.
Kessler, D. and McClellan, M. (1996). Do Doctors Practice Defensive Medicine?, Quarterly Journal of Economics 111: 353–390.
Kessler, D. P. (2011). Evaluating the Med Malpractice System and Options for Reform, Journal of Economic Perspectives 25(2): 93–110
Kessler, D. P. and McClellan, M. (2002). Malpractice law and health care reform: optimal liability policy in an era of managed care, Journal of Public Economics 84: 175–197.
Kilgore, M., Morrisey, M. and Nelson, L. (2006). Tort Law and Medical Malpractice Insurance Premiums, Inquiry 43.
Klick, J. and Stratmann, T. (2007). Medical Malpractice Reform and Physicians in High-Risk Specialties, Journal of Legal Studies 36(S2): 121–142.
Lo Scalzo, A., Donatini, A., Orzella, L., Cicchetti, A., Profili, S. and Maresso, A. (2009). Italy Health system review, Health Systems in Transition - European Observatory on Health Systems and Policies 11 (6): 1 – 216.
Mello, M. (2006). Understanding medical malpractice insurance: A primer, Research Synthesis Report N. 8, Princeton, NJ, The Robert Wood Johnson Foundation .
Mello, M. (2006b). Medical malpractice: Impact of the crisis and effect of state tort reforms, Research Synthesis Report N. 10, Princeton, NJ, The Robert Wood Johnson Foundation .
Mello, M. and Kachalia, A. (2010). Evaluation of Options for Medical Malpractice System Reform, MedPAC 10-2: 1–75.
MoH (2006). Rapporto sulla prima rilevazione nazionale relativa agli ’aspetti assicurativi in ambito di gestione aziendale del rischio clinico’, Ministero della Salute, Roma .
Scarso, A. P. and Foglia, M. (2011). Medical Liability in Europe: A Comparison of Selected Jurisdictions, Vol. Tort and Insurance Law, Berlin/New York: De Gruyter, chapter Medical Liability in Italy, pp. 329–359.
Sloan, F. A. (1985). State Responses to the Malpractice Insurance ’Crisis’ of the 1970s: An Empirical Assessment, Journal of Health Politics, Policy and Law 9 (4)Winter: 629–646.
Sloan, F. A. (1990). Experience Rating: Does It Make Sense for Medical Malpractice Insurance?, The American Economic Review 80(2): 128–133.
Sloan, F. A. and Shadle, J. H. (2009). Is there empirical evidence for ’Defensive Medicine’? A reassessment, Journal of Health Economics 28(2): 481–491.
Studdert, D. M., Mello, M., Sage, W. M., DesRoches, C., Peugh, J., Zapert, K. and Brennan, T. A. (2005). Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment, Journal of the American Medical Association 293(21): 2609–2617.
Taroni, F., De Palma, A. and Cicognani, A. (2008). Principi e pragmatismo nella gestione del rischio: evidenze empiriche e priorità per la riforma, Medicina e Diritto 3: 74–89.
Thorpe, K. (2004). The Medical Malpractice ’Crisis’: Recent Trends and the Impact of State Reforms, Health Affairs pp. 4–20.
Towse, A. and Danzon, P. (1999). Medical Negligence and the NHS- An Economic Analysis, Health Economics 8: 93–101.
U.S. Department of Justice and Federal Trade Commission (2010). Horizontal Merger Guidelines, Technical report.
Vidmar, N., Lee, P., MacKillop, K., McCarthy, K. and McGwin, G. (2005). Seeking the ’Invisible’ Profile of Medical Malpractice Litigation: Insights from Florida, DePaul Law Review 54: 315.
Viscusi, K. and Born, P. (2005). Damages Caps, Insurability, and the Performance of Medical Malpractice Insurance, The Journal of Risk and Insurance 72 (1): 23–43.
Williams, C. and Mello, M. (2006). Medical Malpractice: Impact of the Crisis and Effect of state tort reforms, The Synthesis Project, Policy Brief 10: 1–4.
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