Recent studies argue that different types of patients are affected differently by changes in malpractice pressure. We argue that defensive medicine causes these differential effects. Our theoretical model predicts that reduced malpractice pressure decreases health care spending among patients with good access to care, but increases spending among those with poor access. We test this theory by estimating the effects of tort reforms on birth by cesarean section. Reduced malpractice pressure through collateral source rule reform decreases C-section rates by 4.75% for mothers with timely initiation of prenatal care. On the other hand, reduced pressure through noneconomic damages caps increase C-section rates by 7.59% for mothers without timely initiation. These findings are consistent with defensive medicine. Further investigation suggests that reduced pressure improves access to care for vulnerable populations and reduces utilization among well-served consumers. These findings explain the literature’s conflicting assessments of defensive medicine, despite its practice being widespread.

中文翻译：

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医疗事故改革的不同效果：产科防御医学

最近的研究认为，不同类型的患者受到医疗事故压力变化的影响不同。我们认为防御性医学会导致这些不同的影响。我们的理论模型预测，医疗事故压力的降低会降低获得良好医疗服务的患者的医疗保健支出，但会增加获得医疗服务差的患者的医疗保健支出。我们通过估计侵权改革对剖宫产分娩的影响来检验这一理论。通过间接来源规则改革减少医疗事故压力，及时开始产前护理的母亲的剖腹产率降低了 4.75%。另一方面，通过非经济损失上限降低压力会使未及时启动的母亲的剖腹产率增加 7.59%。这些发现与防御性医学一致。进一步的调查表明，减轻压力可以改善弱势群体获得护理的机会，并降低服务良好的消费者的使用率。这些发现解释了文献对防御性医学的相互矛盾的评估，尽管它的实践很普遍。