Abstract 18: Impact of Malpractice Damage Caps on Cardiac Stress Testing and Medicare Spending

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Steven A Farmer ◽  
Ali Moghtaderi ◽  
Nicole E Hovey ◽  
Bernard S Black
Keyword(s):  
Medical Malpractice ◽  
Fixed Effects ◽  
Stress Testing ◽  
Healthcare Spending ◽  
Third Wave ◽  
Level Data ◽  
Before And After ◽  
Malpractice Liability ◽  
Cardiac Testing ◽  
Medicare Spending

Objective: Physicians report that they often order tests to reduce medical malpractice liability risk. We test the hypothesis that caps on non-economic damages (the most stringent commonly adopted reform) will decrease cardiac testing rates, or healthcare spending more generally, using patient-level data for the Medicare population. Methods: We fit a difference-in-differences model on a 5% random sample of Medicare claims between 1999 and 2012. Treatment states (n=9) were those that introduced damage caps during the “third wave” of medical malpractice reform between 2002 and 2005. The remaining states were controls. We compared rates of cardiovascular stress testing and overall spending per enrollee before and after damage caps were adopted. Our model incorporates extensive covariates: individual and zip-code fixed effects; calendar quarter dummies; patient age; the 17 elements of the Charlson comorbidity index, and county-level demographic, socioeconomic, and health care characteristics. Results: Damage caps did not significantly affect total Medicare spending per enrollee (coefficient +0.31%, 95% confidence interval [CI] [-0.44%, 1.06%]); part A (Inpatient) spending (coefficient +0.79%, 95% CI [-0.05%, 1.64%]) or part B (Outpatient) spending (coefficient +0.02%, 95% CI [-0.64%, 0.67%]). Damage caps predict a statistically significant but clinically modest rise in stress testing rates (annual increase = 0.31%, 95% CI [0.04%, 0.58 %]). This is a 2.5% increase in the likelihood that an individual will receive a cardiac test in a given year. Conclusions: We find no evidence that introduction of damage caps in 9 states in the 2000s decreased either cardiac testing or overall healthcare spending when compared with states without these reforms. Indeed, we find a modest increase in cardiac testing rates, and point estimates for overall spending are also positive. We thus provide evidence against the hypothesis that damage caps reduce overtesting or overall spending.

scholarly journals Evaluating the Medical Malpractice System and Options for Reform

2011 ◽  
Vol 25 (2) ◽  
pp. 93-110 ◽  
Author(s):  
Daniel P Kessler
Keyword(s):  
Medical Malpractice ◽  
Healthcare Providers ◽  
Healthcare Spending ◽  
The United States ◽  
Defensive Medicine ◽  
Cost Of Health Care ◽  
Malpractice Law ◽  
Patient Health ◽  
Malpractice Liability ◽  
The U.S

The U.S. medical malpractice liability system has two principal objectives: to compensate patients who are injured through the negligence of healthcare providers and to deter providers from practicing negligently. In practice, however, the system is slow and costly to administer. It both fails to compensate patients who have suffered from bad medical care and compensates those who haven't. According to opinion surveys of physicians, the system creates incentives to undertake cost-ineffective treatments based on fear of legal liability—to practice “defensive medicine.” The failures of the liability system and the high cost of health care in the United States have led to an important debate over tort policy. How well does malpractice law achieve its intended goals? How large of a problem is defensive medicine and can reforms to malpractice law reduce its impact on healthcare spending? The flaws of the existing system have led a number of states to change their laws in a way that would reduce malpractice liability—to adopt “tort reforms.” Evidence from several studies suggests that wisely chosen reforms have the potential to reduce healthcare spending significantly with no adverse impact on patient health outcomes.

The Element of Surprise: Election Timing and Opposition Preparedness

2021 ◽  
pp. 001041402199717
Author(s):  
Charles T. McClean
Keyword(s):  
House Of Representatives ◽  
Fixed Effects ◽  
Conventional Wisdom ◽  
Economic Conditions ◽  
Alternative Mechanism ◽  
Election Campaigns ◽  
Electoral Accountability ◽  
Fixed Effects Models ◽  
Level Data ◽  
Election Timing

How can incumbent governments benefit when they control the timing of elections? The conventional wisdom is that incumbents gain an advantage by timing elections to coincide with favorable economic conditions. An alternative mechanism that has received less attention is the element of surprise: the incumbent’s ability to exploit the opposition’s lack of election preparedness. I theorize and empirically test this surprise mechanism using candidate-level data from Japanese House of Representatives elections (1955–2017). The results show that in surprise elections, opposition parties recruit fewer, lower-quality candidates, spend less money campaigning, coordinate their candidates less effectively, and ultimately receive fewer votes and seats. Evidence from fixed effects models and exogenously timed by-elections further suggest that surprise matters more in shorter, competitive election campaigns and helps incumbents more with confronting inter-party as opposed to intra-party electoral competition. These findings add to our understanding of how strategic election timing can undermine electoral accountability.

Missing Data in Research on Youth and Family Programs

2021 ◽  
pp. 003329412110268
Author(s):  
Jaime Ballard ◽  
Adeya Richmond ◽  
Suzanne van den Hoogenhof ◽  
Lynne Borden ◽  
Daniel Francis Perkins
Keyword(s):  
Missing Data ◽  
Statistical Methods ◽  
Self Report ◽  
Program Participation ◽  
Multilevel Data ◽  
Individual Level ◽  
Level Data ◽  
Before And After ◽  
Post Test ◽  
The Individual

Background Multilevel data can be missing at the individual level or at a nested level, such as family, classroom, or program site. Increased knowledge of higher-level missing data is necessary to develop evaluation design and statistical methods to address it. Methods Participants included 9,514 individuals participating in 47 youth and family programs nationwide who completed multiple self-report measures before and after program participation. Data were marked as missing or not missing at the item, scale, and wave levels for both individuals and program sites. Results Site-level missing data represented a substantial portion of missing data, ranging from 0–46% of missing data at pre-test and 35–71% of missing data at post-test. Youth were the most likely to be missing data, although site-level data did not differ by the age of participants served. In this dataset youth had the most surveys to complete, so their missing data could be due to survey fatigue. Conclusions Much of the missing data for individuals can be explained by the site not administering those questions or scales. These results suggest a need for statistical methods that account for site-level missing data, and for research design methods to reduce the prevalence of site-level missing data or reduce its impact. Researchers can generate buy-in with sites during the community collaboration stage, assessing problematic items for revision or removal and need for ongoing site support, particularly at post-test. We recommend that researchers conducting multilevel data report the amount and mechanism of missing data at each level.

Antecedents of growth-oriented entrepreneurship before and during the Greek economic crisis

2017 ◽  
Vol 24 (3) ◽  
pp. 528-544 ◽  
Author(s):  
Ioannis Giotopoulos ◽  
Alexandra Kontolaimou ◽  
Aggelos Tsakanikas
Keyword(s):  
Work Experience ◽  
Early Stage ◽  
New Ventures ◽  
High Growth ◽  
Content Type ◽  
Crisis Period ◽  
Individual Level ◽  
Level Data ◽  
The Social ◽  
Before And After

Purpose The purpose of this paper is to explore potential drivers of high-growth intentions of early-stage entrepreneurs in Greece before and after the onset of the financial crisis of 2008. Design/methodology/approach To this end, the authors use individual-level data retrieved from Global Entrepreneurship Monitor annual surveys (2003-2015). Findings The results show that high-growth intentions of Greek entrepreneurs are driven by different factors in the crisis compared to the non-crisis period. Male entrepreneurs and entrepreneurs with significant work experience seem to be more likely to be engaged in growth-oriented new ventures during the crisis period. The same appears to hold for entrepreneurs who are motivated by an opportunity and also perceive future business opportunities in adverse economic conditions. On the other hand, the educational level and the social contacts of founders with other entrepreneurs are found to drive ambitious Greek entrepreneurship in the years before the crisis, while they were insignificant after the crisis outbreak. Originality/value Based on the concept of ambitious entrepreneurship, this study contributes to the literature by investigating the determinants of entrepreneurial high-growth expectations in the Greek context emphasizing the crisis period in comparison to the pre-crisis years.

scholarly journals Obligations, consent and contracts in Scots law: re-analysing the basis of medical malpractice liability in light of Montgomery v Lanarkshire Health Board

Legal Studies ◽  
2021 ◽  
pp. 1-21
Author(s):  
Jonathan Brown
Keyword(s):  
Informed Consent ◽  
Legal System ◽  
Medical Malpractice ◽  
Health Board ◽  
Medical Negligence ◽  
University Hospitals ◽  
Malpractice Liability ◽  
Patient Relationships ◽  
Physician Patient ◽  
Medical Regime

Abstract Professors MacQueen and Thomson have defined ‘contract’, within Scots law, as denoting ‘an agreement between two or more parties having the capacity to make it, in the form demanded by law, to perform, on one side or both, acts which are not trifling, indeterminate, impossible or illegal’. This definition reflects the fact that Scottish contracts are underpinned by consent, rather than by ‘consideration’. This, naturally, has the potential to be of great significance within the context of physician/patient relationships, particularly since the 2006 case of Dow v Tayside University Hospitals NHS Trust acknowledged that these relationships could be contractual in nature. This observation is of renewed importance since the landmark decision in Montgomery v Lanarkshire Health Board, which found that physicians must ensure that they obtain full and freely given ‘informed consent’ from their patients, prior to providing medical services. In light of the present medical regime which requires ‘doctor and patient [to] reach agreement on what should happen’, the basis of liability for medical negligence, in Scotland, requires reanalysis: ‘To have a contract only when the patient pays is not consistent with a legal system which has no doctrine of consideration in contract’.

scholarly journals Betrayed by the Elites: How Corruption Amplifies the Political Effects of Recessions

2021 ◽  
pp. 001041402110474
Author(s):  
Carlos Sanz ◽  
Albert Solé-Ollé ◽  
Pilar Sorribas-Navarro
Keyword(s):  
Great Recession ◽  
Fixed Effects ◽  
Political Corruption ◽  
The Political ◽  
Difference In Difference ◽  
The Great Recession ◽  
Level Data ◽  
Political Effects ◽  
History Of ◽  
Municipal Level

We investigate whether corruption amplifies the political effects of economic crises. Using Spanish municipal-level data and a difference-in-difference strategy, we find that local unemployment shocks experienced during the Great Recession (2008–2015) increased political fragmentation. This effect was four times larger in municipalities exposed to malfeasance than in municipalities without a history of political corruption. We bolster this evidence by showing that, conditional on province and population strata fixed effects, there is no evidence of differential pre-trends. We also find that the interaction of unemployment and corruption harms the two traditional main parties and benefits especially the new party on the left ( Podemos).

scholarly journals The Practical Effect of New Ethics Rules: Responding to Subpoenas and Document Requests About Client Information

2018 ◽  
Vol 36 (2) ◽  
pp. 157-168
Author(s):  
Steven L. Lovett
Keyword(s):  
Public Policy ◽  
Practical Application ◽  
The Public ◽  
Fair Disclosure ◽  
Judicial Efficiency ◽  
Discovery Phase ◽  
Model Rule ◽  
Before And After ◽  
Malpractice Liability ◽  
Practical Effect

            This article is a comparative overview of the American Bar Association’s Model Rule 1.6(b) before and after the issuance of the ABA’s Formal Opinion 473, issued on February 17, 2016, which was an attempt to restate and revise the rule’s ethical expectations and to help settle several questions that had plagued the rule’s practical application. A lawyer’s duty of confidentiality to his or her client, and the public policy favoring judicial efficiency and fair disclosure during the discovery phase of litigation, often places lawyers in precarious ethical positions. This article attempts to provide guidance on this issue through an analysis of the rule and the context in which a lawyer’s overarching duty to keep his or her client’s information confidential can be precluded by the lawful compulsion to disclose such information without incurring malpractice liability.  

scholarly journals Learning loss due to school closures during the COVID-19 pandemic

2021 ◽  
Vol 118 (17) ◽  
pp. e2022376118 ◽  
Author(s):  
Per Engzell ◽  
Arun Frey ◽  
Mark D. Verhagen
Keyword(s):  
The Netherlands ◽  
Fixed Effects ◽  
School Funding ◽  
Learning Loss ◽  
School Closures ◽  
Cumulative Impact ◽  
School Year ◽  
Before And After ◽  
Face To Face Instruction ◽  
Rich Data

Suspension of face-to-face instruction in schools during the COVID-19 pandemic has led to concerns about consequences for students’ learning. So far, data to study this question have been limited. Here we evaluate the effect of school closures on primary school performance using exceptionally rich data from The Netherlands (n ≈ 350,000). We use the fact that national examinations took place before and after lockdown and compare progress during this period to the same period in the 3 previous years. The Netherlands underwent only a relatively short lockdown (8 wk) and features an equitable system of school funding and the world’s highest rate of broadband access. Still, our results reveal a learning loss of about 3 percentile points or 0.08 standard deviations. The effect is equivalent to one-fifth of a school year, the same period that schools remained closed. Losses are up to 60% larger among students from less-educated homes, confirming worries about the uneven toll of the pandemic on children and families. Investigating mechanisms, we find that most of the effect reflects the cumulative impact of knowledge learned rather than transitory influences on the day of testing. Results remain robust when balancing on the estimated propensity of treatment and using maximum-entropy weights or with fixed-effects specifications that compare students within the same school and family. The findings imply that students made little or no progress while learning from home and suggest losses even larger in countries with weaker infrastructure or longer school closures.

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