Objective: This study examines the effect of physician medical malpractice liability exposure on primary Cesarean and vaginal births after Cesarean (VBACs).
Data sources/study setting: Secondary data on hospital births from Florida Hospital Inpatient File, physician characteristics from American Medical Association Physician Masterfile, and physician malpractice claim history from Florida Office of Insurance Regulation.
Study design: Our study estimates the effects of physician malpractice liability exposure on Cesareans and VBACs using panel data and a multivariate, fixed effects model.
Data collection: We merge three secondary data sources based on unique physician license numbers between 1994 and 2010.
Principal findings: We find no evidence that the first malpractice claim affects primary Cesarean deliveries. We find, however, that the first malpractice claim decreases the likelihood of a VBAC (conditional on a prior Cesarean delivery) by 1.2-1.9 percentage points (approximately 10 percent relative to mean VBAC incidence). This finding is robust to focusing on obstetrics-related malpractice claims, as well as to considering different malpractice claims (first report, first severe report, and first lawsuit).
Conclusions: Given the increase in both primary and repeat Cesarean deliveries, our results suggest that physician malpractice liability exposure is responsible for a relatively small share of the VBAC decrease.
Keywords: Cesarean; Medical malpractice; defensive medicine; physician liability; vaginal births after Cesarean.
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