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OCR for page 233
Index
A. M. Best Company, 93-94, 95, 114-115
Academic medical centers
access to care in, 85-87
computer networking of diagnostic
data, 84
costs of malpractice insurance for fac-
ulty, 8, 85, 86
faculty in-house availability, 83, 84
low-income-patient caseload, 86
maternity care providers in, 19
practice of obstetrics in, 7-8, 82-87
teaching changes, 7-8, 84, 85, 125,
152
see also Residents, obstetrical
Access to obstetrical services
in Community and Migrant Health
Centers, 68-69
ethical issues, 4
infant mortality and, 27
for low-income women, 7, 12, 25,
68-69, 147, 198-205
in rural areas, 29-30, 47-49, 86-87,
147, 150
threat of liability and, 2, 10, 68-69,
84, 125, 126, 150-151, 153
see also Obstetrical care
Aid to Families with Dependent Children,
56
Alabama
changes in obstetrical practice in, 189,
198, 207, 212
malpractice insurance costs in, 42-43,
61
Alphafetoprotein testing, 84
Alternative Medical Liability Act, 142
American Academy of Family Physicians
233
survey on changes in obstetrical care,
17-18, 46, 188, 194-195, 203-204,
211, 215
survey of insurance premium costs of
members, 42
American College of Nurse-Midwives, 18,
104, 217
American College of Obstetricians and
Gynecologists (ACOG)
membership size, 15, 19-20, 187
Nurses' Association of, 19-20
Standards for Obstetric-Gynecologic
Services, 117
survey on changes in obstetrical prac-
tice, 2, 38, 41, 187-188, 195, 204,
215
American Law Institute, 132
American Medical Association
endorsement of patient compensation
funds, 121
estimates of growth of malpractice pre-
miums, 2, 110
Physician Master File, 15
-Specialty Society's fault-based admin-
istrative system, 11, 131, 137-139,
154, 157
survey on changes in obstetrical prac-
tice, 215
Amniocentesis, 32, 84, 157
Anesthesia, 84
Apgar scores, 79, 80, 157
Arizona
changes in obstetrical practice in, 189,
198, 207, 212
obstetrical practice patterns in, 46,
47
OCR for page 234
234 INDEX
Arkansas
malpractice claims frequency in, 2
malpractice insurance premiums in,
61, 95-96
Asphyxia, 77, 80, 81-82, 157, 158, 159
Aspiration, 80
Association of American Medical Colleges,
36, 86
Association of Professors of Gynecology
and Obstetrics, 82
Attorneys' fees, 64, 127, 158, 159
Birthrates, 25, 31
Brain damage, claims for, 76-77, 81, 151;
see also Cerebral palsy
Bureau of Health Professions, 31
California
changes in obstetrical practice in, 47,
189, 198, 207, 212
malpractice insurance premiums in,
61, 97, 98, 101, 110
physician fee increases in, 110
California Hospital Association, 135
California Medical Association, 135
Careers.in obstetrics, changes in, 36-37,
84-86
Centre for Socio-Legal Studies, 134
Cerebral palsy, 77, 79-82, 151-162, 158
Cesarean deliveries
in academic medical centers, 82-83
charges for, 24
defensive, 76, 84
description of, 158
electronic fetal monitoring and, 75, 82,
151
by family practitioners, 18, 45
growth in, 8, 32, 75-76, 82-83, 151
and malpractice claims, 76
and malpractice insurance premiums,
101
maternal morbidity and mortality, 76
reasons for, 75-76, 83, 84
repeat procedures, 75
Charity care, decline in, 27
Children's Defense Fund, 20-21, 27
Chorionic villi sampling, 32, 158
Claims, see Malpractice claims and
awards
Clinics, 20, see also Community and Mi-
grant Health Centers; freestanding
birth centers
CNA Insurance Company, 50, 216, 219
Colorado Physician Insurance Company,
118, 216, 224
Colorado Physician Mutual Company, 101
Community and Migrant Health Centers
availability of obstetrical care in, 7,
65-71, 143
budgets, 22-23
caseloads, 5, 20, 22, 23, 67
characteristics of, 22, 23, 159
claims experience of, 66-67
deliveries in, 23
Federal Ibrt Claims Act coverage for,
12, 143-144, 155
liability concerns of, 65-66, 69-70,
150
malpractice insurance premium costs,
66, 67, 68, 70-71, 142
quality of care in, 69-70
reduction and elimination of services,
68-69, 150-151
referral arrangements of, 22, 68-69,
70-71, 144
staffing, 22, 67-68, 70, 143
Consigner Price Index, medical care com-
ponent of, 97-98, 100, 105
Costs of obstetrical care
in birth clinics, 51
dilation and curettage, 113
electronic fetal monitoring and, 82,
151
follow-up hospital visits, 110, 112
geographic differences in, 24
in hospitals, 24, 51
hysterectomy, 113
malpractice insurance premiums and,
109-112, 149
office visits, 110-112
by type of provider, 111-113
and willingness of patients to sue, 1
Council on Medical Specialty Societies,
117
Deliveries (births)
access to services for, 48, 69, 70, 117
breech, 75, 83, 84, 118, 158
discontinuance of care at time of, 70
forceps, 75, 83, 84, 117-118, 160
in hospitals, by ownership status of
hospital, 23
malpractice insurance costs per, 43-44
and,,maternal mortality, 76
Medicaid, 23
no-payment, 23, 44
oxytocin protocols, 118, 163
premature labor, 118, 163
vacuum extraction, 117-118, 164
see also Cesarean deliveries
Doctors' Company of California, 101, 221
Dumping of women in labor, 29, 159
Education, see Academic medical centers;
Residents, obstetrical
Electronic fetal monitoring
and cerebral palsy, 77, 79-80, 81-82
and cesarean deliveries, 75, 82, 151
computer networks for evaluation of
tracings, 83, 84
costs of, 82, 151
description of, 159
effectiveness of, 8, 12, 76, 77, 79,
81-82
evaluation of technology, 78-79, 117,
151, 155
history of, 77-78, 159
and malpractice claims, 76-77, 81
OCR for page 235
INDEX 235
and neonatal seizures, 79
prevalence of, 32, 52, 77 84, 151
randomized clinical trials of, 78, 79,
81, 163
recordkeeping for, 117
reimbursement rates for, 78
Employment Retirement Income Security
Act, 159-160
Ethical issues
dumping of women in labor, 29, 159
obligations of medical professions, 4-5
obligations of society, 4
private contracts approach to claims
resolution, 140-141
termination of care at time of delivery,
70
Family and general practitioners
changes in obstetrical practice, 5-7,
17-18, 29, 35, 38, 42, 44-48, 59,
69, 70, 74, 86-87, 149-150,
198-205, 207-212
charges for services, 44
claims experience of, 45, 101, 104
in Community and Migrant Health
Centers, 22
deliveries per year, 43
education/training of, 15, 18, 160
expenses of, 108
fee increases, 110-113
income, 105-109
liability concerns of, 44-45, 207-211
malpractice insurance premiums for, 9,
42-44, 95, 98, 101, 105, 107-109,
148
no-pay caseloads, 44
number in U.S., 15-17, 37, 45
patient characteristics, 15, 45
population ratios for, 16-17
services performed by, 45, 160
Federal Ibrt Claims Act, 12, 143-144,
155, 160
Fetal bradycardia, 80, 158
Florida
Academic Task Force for Review of the
Insurance and Tort Systems, 114,
115, 120
malpractice insurance premiums in,
61, 97, 110
no-fault compensation system, 11, 122,
128, 133, 136, 137
obstetrical practice changes in, 41
Patient Compensation Fund, 121
physician fee increases in, 110
Tort Reform and Insurance Act of
1986, 122
Food and Drug Administration, licensing
~ of medical technologies, 76
Food, Drug, and Cosmetic Act, 78
Freestanding birth centers, 19, 49-51, 160
General practitioners, see Funnily and
general practitioners
Geographic differences
in claims frequency for physicians, 2,
36
in costs of maternity care, 24
in financing of obstetrical care, 55
in malpractice insurance premiums,
42-43, 60-62, 95-97, 99, 101
malpractice problems of Community
and Migrant Health Centers, 66
in Medicaid participation by physi-
cians, 58-59
in obstetrical practice patterns, 41,
198-205, 207-215
in physician charges for services, 44,
149
in physician numbers and population
ratios, 16-17
in providers of maternity care, 5, 6,
15-19, 29-30, 42, 44, 47-48,
198-205, 207-211
Georgia
changes in obstetrical practice in,
41-42, 47, 190, 199, 208, 212-213
physician numbers and population ra-
tios, 16, 47
Graduate Medical Education Advisory
Committee, 31
Harvard Medical Institutions, 116-118
Harvard Medical Practice Study Group,
135
Harvard Risk Management Foundation,
77, 116, 117
Hawaii, liability coverage for Medicaid
providers in, 12, 155
Health Care Financing Administration,
Effectiveness Initiative, 12, 154-155
Health care providers, see Family and
general practitioners; Nurse-mid-
wives; Obstetrician-gynecologists;
Physicians
Health Care Quality Improvement Act of
1986, 11, 154
Health departments, see Public health
agencies/programs
Health insurance
catastrophic, 56
and cesarean deliveries, 76
extent of coverage for maternity care,
24-25, 26
waiting periods, 25
see also Uninsured women
Health maintenance organizations, 4, 19,
76, 93, 140, 160, 226
High-risk women
birthrates among, 31-32
characteristics of, 31, 74-75, 160
data bases for identification of, 116
Medicaid reimbursement for care of,
62
reduction of care to, 38-42, 58-60, 84,
147, 150, 152, 198-205
referral sources for, 45
see also Low-income women; uninsured
women
In
OCR for page 236
236 INDEX
Hospitals
closures of obstetrical units, 48
costs of maternity care in, 24
dumping of women in labor, 29, 159
Hill-Burton uncompensated service
obligations, 161
investor-owned, 23-24, 160
limits of malpractice coverage, 96, 121
malpractice insurance sources, 93, 97
maternity care providers in, 19, 51-52
maternity services of, 5, 23
not-for-profit, 23-24, 162
obstetrical beds in, 23-24
preadmission cash deposits, 29
prenatal care caseloads, 20
public, 5, 23-24
reduction of emergency deliveries, 59
university, see Academic medical cen-
ters
Hypoxia, 79-80
Hysterectomy, 110, 113
Idaho, changes in obstetrical practice in,
47, 190, 199, 208, 213
Illinois
changes in obstetrical practice in, 47,
190, 199, 213
malpractice insurance premiums in,
60-61, 97
Medicaid reimbursements for normal
deliveries in, 60-61
Infant mortality, 27, 59, 79, 160, 161
Informed consent, 8, 74, 118, 152, 161
Institute of Medicine, Council on Health
Care Technology, 155
Insurance, see Health insurance; Malprac-
tice insurance
Insurance industry
property-casualty, profitability of,
114-115, 149
regulation of, 3, 93, 95, 96, 101, 123
reinsurance companies, 96, 114
risk management activities of, 9, 149,
164
role in liability crisis, 1, 3, 149
see also Malpractice insurance
Insurance Information Institute, 115
Intensive care, neonatal, 79, 80
Joint underwriting associations, 9, 51,
92, 94, 120, 161
Kansas
changes in obstetrical practice in, 191,
200, 213
market share of joint underwriting as-
sociations in, 94
Kentucky
changes in obstetrical practice in, 191,
200, 208, 213
physician participation in Medicaid in, 58
King's Fund Institute, 134
Liability Risk Retention Act, 94
Low birthweight, 26, 59, 80, 160
Low-income women
access problems of, 6-7, 12, 25, 31, 54,
59-65, 74-75, 147, 150
characteristics of, 25, 27
claims settlements for, 64
continuity of care for, 63
effects of liability crisis on, 54-71,
147, 150
infant mortality among, 59
litigation propensity of, 64-65, 87-88,
150
low-birthweight infants, 59
sources of obstetrical care, 5, 14-15,
20-23, 65, 86, 150
survey of access problems of, 47-48
see also High-risk women; Medicaid;
Uninsured women
Madden v. Kaiser Foundation Hospitals,
141
Malpractice claims and awards
for brain damage, 76-77, 81
cesarean deliveries and, 76
against Community and Migrant
Health Centers, 66-67
consumer expectations of medicine
and, 3, 88
data bases on, 11-12, 116-117
defined, 2 nil, 158-159
effects on insurance premium costs, 2
electronic fetal monitoring and, 76-77,
81
financial reasons for 88
frequency and severity of, 2, 10, 65,
88, 96, 113, 127, 130, 148, 149,
153, 158-159
growth of, 2, 125
limits on, 95, 122, 127; see also No
fault compensation
for lost earnings, 64
by low-income women, 64-65, 87-88
against nurses and nurse-midwives
20, 50
against obstetrician-gynecologists, 2,
51, 63
physician costs associated with, 110
against public health agency physi
cians, 67
public perceptions of physicians and, 3,
88
tort reforms and, 10, 127, 130
Malpractice insurance
availability of, 8-9, 96-104, 125, 148
claims-made policies, 9, 96, 97, 104,
148, 162
coverage limits, 95-96
economic burden of, 50, 149
for federally subsidized providers,
142-143
hospital association-owned companies,
94, 97
from joint underwriting associations
9, 51, 94, 97, 120, 121-122, 148,
160, 164
market size, 95, 114
OCR for page 237
INDEX 237
market structure, 93-104
occurrence-based policies, 84, 96
from physician-owned and medical so-
ciety-created companies, 9, 93-94,
97, 116, 148, 149, 158, 162, 163
profitability of, 112-119, 149
public expenditures on, 67
reserves, 113, 114, 163-164
responsibilities of insurance company,
93
risk retention groups/purchasing
groups, 94-95, 163,164
self-insurance, 93, 97
sources of, 93-94
by specialty, 107
tail coverage, 84, 86, 96,162
see also Risk management activities
Malpractice insurance premiums
and accumulated exposure theory, 70
affordability of, 9, 97, 104-112,
148-149
and availability of obstetrical care, 59,
67-68, 69-70
bases for, 95-96, 102-103, 104,
113-114, 122-123 164
and careers in obstetrics 36
costs per delivery, 43-4i
cross-subsidization of specialties, 120
defined, 161-162
discounts as risk management incen
tives, 119, 164
experience rating of physicians and,
122-123, 160, 219-225
factors affecting, 2, 109-113, 125
for family/general practitioners, 9, 42
44, 95, 98, 100-101, 105-109, 148
federal subsidization of, 12, 144, 145,
155
and fee increases, 109-112, 149; see
also Costs of obstetric care
geographic differences in, 42-43,
60-62, 95-96, 97, 99, 101
increases in, 2, 93, 97-98, 100, 107,
109-112, 114, 125
insurer expenses covered by, 113
and Medicaid reimbursement rates, 60
for nurse-midwives, 9, 50-52, 95-96,
104, 105-106, 112, 148
for obstetrician-gynecologists, 2, 8, 35,
52, 97-101, 105-109, 148
as a percentage of expenses, 106-108
as a percentage of income, 105-109
and quality of care, 69-70
risk classifications, 95, 98, 101,
102-103, 120, 164
for self-employed physicians, by spe
cialty, 100, 108-109
strategies for reducing, 119-122
surcharges, 52, 104, 120-123, 219-225
taxes, 93
tort reforms and, 130
Maryland
changes in obstetrical practice in, 46,
191, 200, 208, 213
claims by Medicaid recipients in, 64
liability coverage for Medicaid pro-
viders in, 12, 128, 144, 145, 155
physician participation in Medicaid in,
58
Massachusetts
changes in obstetrical practice in, 41,
191, 200, 213
malpractice claims in, 76
Medicaid eligibility in, 56
Maternal and Child Health agencies,
47-48, 57, 59
Maternity care, see Obstetrical care; Pre-
natal care
Maternity Center Association, 51
Medicaid
application processing, 57
benefits, 56
births paid for by, 55, 56
claims payment systems, 57
delays in reimbursements, 57
description of, 162
differential between private reimbur
sement and, 58
eligibility, 54, 56-57,162,163
expenditures per birth, 55
liability coverage for providers, 12-13.
144-145, 155-156
physician participation in, 7, 54-55,
57-59, 69, 150
reforms in, 56-57, 62-63
reimbursement of nurse-midwives,
48-49
reimbursement policy, 56, 57-58,
60-62, 79, 121
role in delivery of obstetrical care,
55-65
state variation in programs, 56, 60-61
Medicaid patients, see Low-income women
Medical Devices Act of 1976, 78
Medical Liability Mutual Insurance Com-
pany, 93-94, 98, 102-103, 216, 219
Medical Malpractice Insurance Associa-
tion, 51
Medical technology
assessment of, 12, 78-79, 154-155
consuTner acceptance of, 32
Michigan
changes in obstetrical practice in, 47,
191, 201, 209, 213
malpractice insurance premiums in,
61, 97
Medicaid births in, 55
Missouri
liability coverage for Medicaid pro-
viders in, 12, 144-145, 155
malpractice insurance premiums in,
60-61
Medicaid reimbursements for normal
deliveries in, 60-61
State Legal Expense Fund, 144-145
Myers-Briggs personality test, 119,
162
National Association of Childbearing
Centers, 51
OCR for page 238
238 INDEX
National Center for Health Services Re-
search, Health Care Technology As-
sessment Program on Outcomes
Research, 12, 155
National Collaborative Perinatal Project,
80
National Coordinating Committee on
Medical Malpractice JUAs, 94
National Governors' Association, 47, 59,
196, 205, 211
National Health Service Corps, 13, 22,
143, 144, 156, 162
National Institute of Neurological and
Communicative Disorders and Stroke,
80
National Medical Care Utilization and Ex-
penditures Study, 15, 44
National Resident Matching Program, 36
National Survey of Family Growth, 44
Nevada, changes in obstetrical practice in,
47, 192, 201, 209, 214
New Jersey
malpractice insurance premiums in,
60-61, 98
Medicaid reimbursements for normal
deliveries in, 60-61
New York State
changes in obstetrical practice in, 192,
201, 214
claims experience of obstetricians in,
51
Department of Insurance, 114-116,
120-123
electronic fetal monitoring in, 77
Excess Liability Insurance Pool, 121
joint underwriting associations in, 51,
94
malpractice claims frequency in, 2
malpractice insurance premiums in,
61, 95-96, 97, 98, 101, 121
merit rating plan for malpractice in-
surance premiums, 123
No-fault compensation
cause-based, 134
Childhood Vaccine Injury Compensa-
tion Act, 133
collateral sources of compensation and,
133, 137
cost of claims under, 134, 135
defined, 162
designated compensable events plans,
11, 122, 131-137, 154, 159
eligibility under, 136
Florida plan for, 11, 122, 131, 133,
136, 137, 154
funding for, 137, 227
goals of, 136
indigent care provisions, 137
for loss of bodily function, 134
for loss of wages, 133, 134
number of claims compensated under,
134-135
in other countries, 134-135
for pain and suffering, 133, 134
pay-as-you-go system, 136-137
punitive damages under, 134, 137
research on, 135
Virginia plan for, 11, 122, 131, 133,
136-137, 154, 226-227
Nonstress testing, 52
North Carolina, changes in obstetrical
practice in, 59, 192, 201, 209, 214
Nurse-midwives, certified
births attended by, 48-49
changes in obstetrical practice, 7, 19,
35, 50-52, 150
claims experience of, 20, 50, 104
employers of, 19, 50, 51, 104
fees, 50, 112
income, 19, 50, 105
insurance availability for, 9, 50, 51,
97, 104, 148
job opportunities for, 51, 52, 104, 150
malpractice insurance premiums for, 9,
50-52, 95-96, 104, 112, 148
Medicaid reimbursement of, 48-49
number in U.S., 5, 19
patient characteristics, 5, 15, 19
services provided by, 18, 19, 162-163
training of, 18
Nurse-midwives, lay, 5, 14
Nurses, 19-20
Obstetrical care
consumer acceptance of high technol
ogy in, 32
costs of, 24, 109-113, 125, 147
elimination of, 6, 27, 35, 38-39, 46, 52,
59, 74, 150, 198-205, 212
financing of, 24-25, 26, 27, 44, 54,
143; see also Health insurance;
Medicaid
inability to pay for, 27, 29, 44
projected increase in need for, 30-32
quality of, 69-70
reductions in services, 6--7, 27, 46, 74,
150, 198-205
shortages in U.S., 5-6, 25-32, 47-48,
150
sources of, 14-20
state programs for financing, 25
see also Access to obstetrical services;
Practice of obstetrics
Obstetrician-gynecologists
changes in obstetrical practice, 6-7,
27, 35, 38-42, 47, 59, 74, 87, 150,
198-205, 213
claims experience of, 2, 35-36, 51, 63,
87
in Community and Migrant Health
Centers, 22
deliveries per year, 43, 44
education and training of, 163
expenses of, 106, 107-108
fee increases, 110-113
geographic distribution of, 5, 15-17,
18, 198-205
high-risk-patient caseloads, 39-40.
41-42, 59, 71, 74, 150
income trends, 9, 105-109, 149
OCR for page 239
INDEX 239
job changes by, 85-86
malpractice insurance premiums for, 2,
9, 35, 43, 44, 52, 86, 97-101,
104-109, 148
Medicaid participation rates, 57, 58
no-pay caseloads, 44
number in U.S., 15, 16-17
projected supply of, 31
self-employed, 97-98, 107-108
solo practice by, 75, 84, 85
trends in career choices of graduating
seniors as, 37
Omnibus Budget Reconciliation Act, 54,
56, 62
Oregon, changes in obstetrical practice In,
47, 192, 202, 209, 214
Oregon Medical Society, 44
Pennsylvania, malpractice insurance pre-
miums in, 98
Pennsylvania Hospital Insurance Com-
pany, 94, 216, 219
Pennsylvania Medical Society Liability
Insurance Company, 117-119, 216
Perinatal care, public programs, provider
participation in, 59, 67-68
Physician Insurers' Association of Amer-
ica, 116-117, 217
Physician-patient relationship
effects of liability concerns on, 8, 74,
87-89, 125, 147, 151-153
importance of, 11, 87-88, 152-154
Myers-Briggs personality test and,
119, 162
as a producer-consumer relationship,
3-5, 89, 152-153
and risk management activities, 225
Physicians
availability of malpractice insurance
for, 96-104
disciplinary measures against, 117, 134
educational strategies for risk manage
ment, 118-119
effects of lawsuits on, 44-45, 87, 152
ethical obligations of, 4-5
fear of suits, 63-65, 150
federally subsidized, 142-143
income trends, 105-109
limits of malpractice coverage, 95
Medicaid participation by, 7, 54-55,
57-59, 69, 150
negative attitudes toward patients,
88-89
number of, and population ratios, by
state, 16-17
nurse-midwives as employees of, 19, 50
perceptions of blame for liability crisis,
1, 126
in public health centers, 67, 143-145
public perceptions of, 3
self-employed, 97-98, 107
shortages in rural areas, 29-30
see also Family and general practi
tioners, Nurse-midwives; Obstetri
cian-gynecologists
Physicians Insurance Association of
America, 81
Practice of obstetrics
in academic medical centers, 7-8,
82-87
age of physician and, 38-39
anesthesia in, 84
auscultation, 78, 79
beneficial changes in, 8, 83, 151
consultations with other physicians,
74, 83, 84, 118
diagnostic testing, 8, 32, 52, 73, 83,
84, 110, 117, 118, 152
discussions with patients, 8, 74, 83,
152
by individual physicians, 73-82
informed consent documentation, 8, 74,
118, 152, 161, 225
malpractice issues as a factor in, 39,
41-42, 44-46, 73-89, 125, 147,
149, 151-152
overuse of medically inadvisable pro
cedures, 10, 126
quality assurance, 84
recordkeeping, 8, 83, 84, 110, 11.7, 118,
151
standardization of protocols, 84,
117-118
trends in, 40-42, 52
see also Cesarean deliveries; Deliveries
(births); Electronic fetal monitor
ing; Physician-patient relationship
Premiums, see Malpractice insurance pre-
m~ums
Prenatal care
access to, 26, 48
and cesarean deliveries, 75-76
charges for, 44
effectiveness in improving pregnancy
outcomes, 27
insufficient, 26-28, 32, 84
number of visits, 31
sources of, 5, 20-23
standard of, 32, 163
see also Obstetrical care
Public health agencies/programs
clinics, 5, 20-21
liability coverage for obstetrical pro-
viders in, 144-145
maternity care providers in, 5, 19
physician withdrawal from, 59, 60
reimbursement rates, 60
see also Community and Migrant
Health Centers
Recommendations
data base on claims, 154
federal research support for tort re-
forms, 11, 132, 154
federal tort claims act coverage for ob-
stetrical providers, 12, 143-144,
155
goal of, 11, 153
liability coverage for Medicaid pro-
viders, 12-13, 143-144, 155
OCR for page 240
240 INDEX
National Health Service Corps, 13,
143, 156
resolution of access problems of the
poor, 12
state tort reform efforts, 11, 132, 154
technology assessment, 12, 154-155
Residents, obstetrical
as codefendants in malpractice cases,
84, 85
faculty availability to, 83
in family practice, 18
number of, 36
restriction of activities of, 85
training of, 8, 84, 85, 152
Respiratory distress syndrome, 80, 164
Rhode Island
market share of joint underwriting as-
sociations in, 94
Medicaid eligibility in, 56
Risk management activities
clinical standard setting, 117-118,
164, 221
data gathering and analysis, 116-117,
164, 219, 221, 224, 225
discounted premiums as incentives for,
119, 164, 219, 221-223
educational efforts, 117, 118-119, 164,
219-225
extent of, in obstetrics, 116
by hospitals, 121
by insurance companies, 9, 149
physician commitment to, 63, 84
by physician- or hospital-sponsored or
ganizations, 9, 116, 149
protocol development, 118, 164, 221,
225
survey of, 216-217, 219-225
Robert Wood Johnson Foundation, 54, 132,
135
Rural areas
costs of maternity care in, 24, 44
defined, 164
economic characteristics of medical
practice in, 44
financing of obstetrical care in, 44
health care providers in, 17, 18, 22,
42, 49, 150, 207-212
health of Americans in, 29
liability concerns in, 45
malpractice insurance premiums in,
97
obstetrical care shortages in, 6, 29-30,
47-49, 86-87, 147, 150
Seizures, in newborns, 79, 80
Social Security Act, Title V, 21
South Dakota Medicaid births in, 55
St. Paul Companies, 97, 99, 101, 116,
118-119, 122, 216, 219
Stress testing, 32
Surveys and studies
access to care in rural areas, 207-211
on changes in obstetrical practice pat-
terns, 38, 47-48, 59, 187-196,
198-205
family practitioners' practice changes,
207-211
of liability concerns of public health
centers, 65-66
limitations of, 38, 41, 42, 45, 65, 147,
188
on malpractice claims, 2, 50, 130
methodologies, 37, 41, 45, 65, 147,
187-196
national, 187-188, 194-196, 203-205,
211, 215
of specialties chosen by graduating se
niors, 36-37
state, 188, 189-194, 198-203,
207-210, 212-214
Technology, see Medical technology
Texas, changes in obstetrical practice in,
58, 193, 202, 210, 214
Tort law, defined, 126, 164
Tort Policy Working Group, 114-115
Tort reforms
AMA-Specialty Society's fault-based
administrative system, 11, 131,
137-139, 154, 157
arbitration, 127-129, 140, 141, 157,
225
caps on attorneys' fees, 127-130, 145,
158
changes in tort doctrine, 2, 127-129
collateral source payments, 127-130,
140-142, 159, 226
deleterious side effects of, 127
economic damage guarantee (Moore
Gephardt proposal), 141-142
effectiveness of, 9-10, 127, 130-132,
149, 153
federal research support for, 11
goals of, 164
limits on awards, 2, 127-130, 140, 145
and malpractice insurance premiums,
130
patient compensation funds, 95,
120-121, 128-129
periodic payment of future damages,
127-130
physician disciplining/credentialing,
134, 137, 138
pretrial screening panels, 127-130,
138, 163
private contracts, 11, 131, 139-141,
154
recommended, 11, 131-132
res ipsa loquitur, 127-129, 164
restrictions on informed consent, 127
state efforts on, 11, 127-129
see also No-fault compensation
Tort system
alternatives to, 132-143, 149, 153,
154; see also Tort reforms
goals of, 126
role in medical liability crisis, 9-10,
126, 147, 153
social insurance alternative to,
142-143
OCR for page 241
Toxemia, 118, 165
Tunkl v. Regents of the University of Cali-
forn~a, 141
Ultrasonography, 32, 52, 84, 159, 165, 224
Uninsured women
diminished care of, 84
number in U.S., 25, 27
sources of prenatal care for, 21
see also Low-income women
University of Texas Health Science Cen-
ter, 135
Urban Institute, 135
U.S. Department of Health and Human
Services
expenditures on liability insurance
coverage for staff, 67
funding of pilot projects on tort reform,
11
U.S. Department of Health, Education,
and Welfare, Commission on Medical
Malpractice, 64
INDEX 241
U.S. General Accounting Office, 2,
114-115, 130
U.S. Surgeon General, objectives for in-
fant health, 26
Utah Medical Insurance Association, 117,
118, 216, 225
Virginia
changes in obstetrical practice in, 193,
203, 214
no-fault compensation system, 11, 122,
129, 133, 226-227
Washington
changes in obstetrical practice in,
193-194, 203, 210, 214
claims by Medicaid recipients in, 65
malpractice insurance costs in, 42-43,
62, 101
physician participation in Medicaid
58
West Virginia, changes in obstetrical
practice in, 47, 194, 203, 210, 215
Representative terms from entire chapter:
obstetrical practice
