Malpractice experience and the incidence of cesarean delivery: a physician-level longitudinal analysis

This study examines the influence of malpractice claims on the practice behavior of a panel of obstetricians in Florida during the period 1992-1995 to determine whether physicians respond to malpractice events by performing more cesareans, consistent with the notion that cesarean sections are employed as "defensive medicine." Findings indicate that clinical events resulting in claims that lead to substantial indemnity payments have a significant, modest effect on physician practice behavior: physicians experiencing those claims increase their risk-adjusted cesarean rates by about one percentage point. Malpractice experience does not appear to affect patient mix, but claims with large payouts may affect patient volume.