IMPACT OF MALPRACTICE CAPS ON USE AND OUTCOMES OF RADICAL CYSTECTOMY FOR BLADDER CANCER: DATA FROM THE SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS PROGRAM
Abstract
Purpose:
The impact of malpractice awards on insurance premiums and health care delivery generates much concern. To our knowledge no data exist regarding the impact of caps, or upper limits, on awards for noneconomic damages (also termed pain and suffering) on health care delivery patterns or outcomes. We investigated the effect of caps on the use of and outcomes following aggressive surgical treatment (radical cystectomy) in patients with bladder cancer.
Materials and Methods:
We performed a retrospective cohort study of patients with bladder cancer who underwent radical cystectomy, identified from the Surveillance, Epidemiology, and End Results (SEER) Program database. Cystectomy rates and post-cystectomy disease specific survival were compared between SEER regions with and without a cap, while controlling for other variables.
Results:
A significantly greater proportion of patients with stages III and IV bladder cancer underwent cystectomy in SEER regions with a cap. Cap status was a significant predictor of survival from bladder cancer.
Conclusions:
Radical cystectomy for bladder cancer is performed more often even for advanced bladder cancer in geographic regions with a cap with a positive impact on survival. The institution of caps may have beneficial effects on patterns of health care beyond that of merely decreasing insurance premium costs.
References
- 1 Medical Malpractice and Access to Health Care. Publication GAO-03-836. Washington D. C.: United States General Accounting Office2003. Google Scholar
- 2 MICRA, the State of California Medical Injury Compensation Reform Act, 1975 Google Scholar
- 3 National Physician Survey on Professional Medical Liability. Chicago: American Medical AssociationApril 2003. Google Scholar
- 4 : How liability law affects medical productivity. J Health Econ2002; 21: 931. Google Scholar
- 5 : AJCC Cancer Staging Manual. Philadelphia: Lippincott-Raven Publishers1997: 224. Google Scholar
- 6 Medicare Physician Fee Schedule. Centers for Medicare and Medicaid Services. Available at http://cms.hhs.gov/physicians/mpfsapp/step0.asp. Accessed October 1, 2003 Google Scholar
- 7 United States Department of Labor, Bureau of Labor Statistics. Available at http://www.bls.gov/cpi/cpid0111.pdf. Accessed September 9, 2003 Google Scholar
- 8 : Nonparametric estimation from incomplete observations. J Am Stat Assoc1958; 53: 457. Google Scholar
- 9 : Regression models and life tables. J Roy Stat Soc B1972; 34: 187. Google Scholar
- 10 : Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol2001; 19: 666. Google Scholar
- 11 : Contemporary management of superficial bladder cancer in the United States: a pattern of care analysis. Urology2003; 62: 1083. Google Scholar
- 12 : The new medical malpractice crisis. N Engl J Med2003; 348: 2281. Google Scholar
- 13 : Relationship between malpractice claims and cesarean delivery. JAMA1993; 269: 366. Google Scholar
- 14 : No-fault compensation for medical injuries: the prospect for error prevention. JAMA2001; 286: 217. Google Scholar
- 15 : Hospital volume and surgical mortality in the United States. N Engl J Med2002; 346: 1128. Google Scholar
Departments of Urology (BRK, VD, VA), Epidemiology (BRK) and Biostatistics (VD), University of Iowa, Iowa City and Division of Health Promotion and Education (SAJ), University of Northern Iowa, Cedar Falls, Iowa
