Abstract
BackgroundHow much does the medical malpractice system affect treatment decisions in orthopaedics? To further this inquiry, we sought to assess whether malpractice liability is associated with differences in surgery rates among elderly orthopaedic patients.MethodsMedicare data were obtained for patients with a rotator cuff tear or proximal humerus fracture in 2011. Multivariate regressions were used to assess whether the probability of surgery is associated with various state-level rules that increase or decrease malpractice liability risks.ResultsStudy results indicate that lower liability is associated with higher surgery rates. States with joint and several liability, caps on punitive damages, and punitive evidence rule had surgery rates that were respectively 5%-, 1%-, and 1%-point higher for rotator cuff tears, and 2%-, 2%- and 1%-point higher for proximal humerus fractures. Conversely, greater liability is associated with lower surgery rates, respectively 6%- and 9%-points lower for rotator cuff patients in states with comparative negligence and pure comparative negligence.ConclusionsMedical malpractice liability is associated with orthopaedic treatment choices. Future research should investigate whether treatment differences result in health outcome changes to assess the costs and benefits of the medical liability system.
Highlights
Does the medical malpractice system affect the practice of medicine? We ask this question in the context of orthopaedics, a medical specialty that accounts for $176 billion in direct annual healthcare expenditures and affects one in every two Americans over age 18 [1,2,3]
Beneficiaries diagnosed with proximal humerus fracture (PHF) or atraumatic rotator cuff tear (ARCT) with an index date in 2011 were identified using specific algorithms described below
While patients with ARCT were almost evenly split between men (50.23%) and women (49.77%), PHF patients were overwhelmingly female (80.11%)
Summary
Does the medical malpractice system affect the practice of medicine? We ask this question in the context of orthopaedics, a medical specialty that accounts for $176 billion in direct annual healthcare expenditures and affects one in every two Americans over age 18 [1,2,3]. Does the medical malpractice system affect the practice of medicine? Chen et al BMC Health Services Research (2021) 21:516 direct costs of litigation, medical malpractice may increase costs indirectly through “defensive medicine,” defined as medical practices that reduce legal liability without significant benefit to patients [21, 22]. Concerns over the adverse cost impact of defensive medicine provided the political impetus for medical malpractice liability reforms (and more generally, tort reforms) at the state level in the late 1990s.1. These reforms primarily limited awards to patients or created procedural barriers for patients to sue their physicians [29]. How much does the medical malpractice system affect treatment decisions in orthopaedics? To further this inquiry, we sought to assess whether malpractice liability is associated with differences in surgery rates among elderly orthopaedic patients
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