Relationship between malpractice claims and cesarean delivery

JAMA. 1993 Jan 20;269(3):366-73.


Objective: To investigate whether an association exists between the probability of a cesarean delivery and the level of malpractice claims risk faced by hospitals and physicians.

Design: Survey of computerized discharge data linked with physician and hospital malpractice claims records based on stratified, random sample of hospitals.

Setting: Acute care hospitals in New York State in 1984.

Population: All deliveries (60 490) at 31 hospitals.

Results: After controlling for the clinical risk of a cesarean delivery, patient socioeconomic status, and physician and hospital characteristics, cesarean delivery was positively associated with physician malpractice premiums (odds ratio [OR], 3.00; 95% confidence interval [CI], 2.13 to 4.24 for the difference between upstate and New York City levels), with the number of physician claims opened per 100 physicians at the hospital level (OR, 1.15; 95% CI, 1.02 to 1.30 for a 1-SD change), and with the number of hospital claims opened per 1000 discharges (OR, 1.26; 95% CI, 1.10 to 1.43 for a 1-SD change). Measures of physician-perceived risk of suit also showed a significant association with cesarean delivery (OR, 1.96; 95% CI, 1.53 to 2.52, upstate vs New York City). Within hospitals, there was no significant association (OR, 1.15; P = .126) between the odds of cesarean delivery and the claims history (none vs one or more) of an individual physician.

Conclusion: Results support previous speculations of a positive association between malpractice claims risk and the rate of cesarean delivery.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cesarean Section / statistics & numerical data*
  • Cluster Analysis
  • Confidence Intervals
  • Female
  • Humans
  • Malpractice / statistics & numerical data*
  • Models, Statistical
  • New York
  • Obstetrics / legislation & jurisprudence*
  • Obstetrics and Gynecology Department, Hospital / legislation & jurisprudence*
  • Obstetrics and Gynecology Department, Hospital / statistics & numerical data
  • Odds Ratio
  • Physicians / statistics & numerical data
  • Pregnancy
  • Risk Factors
  • Socioeconomic Factors