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The influence of obstetric no-fault compensation on obstetricians' practice patterns
F A Sloan1, K Whetten-Goldstein, G B Hickson
1Department of Economics and Center for Health Policy, Law and Management, Duke University, Durham, North Carolina 27708, USA.
Objectives:
The objectives were to determine level of satisfaction among obstetricians with the no-fault insurance programs in Florida and Virginia and to study any reported practice patterns attributable to implementation of no-fault compensation.
Study Design:
Structured surveys were conducted with 119 obstetricians in Florida and Virginia.
Results:
More than 90% of obstetricians were enrolled in no-fault insurance programs, but only 13% reported having had a patient compensated by a no-fault program. Only 14% knew of a colleague with a patient who had been compensated. Despite no-fault compensation, threat of lawsuits was a factor in 39% of cases of physicians who quit practicing obstetrics. The no-fault programs did not cause obstetricians to report increases in their obstetric caseloads or in their fraction of patients at high risk. Overall, obstetricians were far more satisfied with the no-fault system than with the tort system. Still, more than half of the respondents expressed dissatisfaction with premiums assessed by no-fault insurance.
Conclusion:
Obstetricians who knew about the no-fault programs were generally satisfied with their performance. However, the no-fault programs have not built a constituency with physicians, and the programs are relatively small in their scope of coverage. No-fault compensation thus has had minor impact on reported obstetric practice. To be effective in improving patient access, no-fault compensation must be broader in scope.