Rethinking Torts: The Effect of Medical Malpractice Reform on Maternal & Infant Health

Many studies have examined the variation in state tort reforms that occurred in the 1980s and 1990s due to a medical malpractice “crises”. However, little research has accounted for the latest crisis that occurred in the mid-2000s where many states adopted tort reform in a relatively short time frame.  Medical malpractice tort reform, specifically, caps on noneconomic damages, have been widely studied in the past.  Obstetricians and gynecologists have been called into question on whether or not they are altering their behavior by engaging in defensive medicine.  More importantly, if medical malpractice tort reform is shown to affect physicians’ procedural choice, how does this consequently affect infant health outcomes? Our paper uses the United States’ linked birth and infant death vital statistics from 1980 to 2012 to analyze how tort reform affects both maternal health through the outcomes of c-sections and complications during delivery, as well as infant health by examining infant mortality and APGAR scores. Possible endogeneity may be present since tort reforms are not created in a vacuum and obstetricians are often the focus of medical malpractice reform movements. Thus, a Two-Stage least squares model is applied where product liability reform is used as an instrumental variable for caps on noneconomic damages. County-fixed effects are included to account for the geographical differences in procedure use.  In addition, models are run separately for different races as there is a strong literature on the racial discrepancies in infant mortality rates.