Cost of racial disparity in preterm birth: evidence from Michigan.

This study examined the economic costs associated with racial disparity in preterm birth and preterm fetal death in Michigan. Linked 2003 Michigan vital statistics and hospital discharge data were used for data analysis. Thirteen percent of the singleton births among non-Hispanic Blacks were before 37 completed weeks of gestation, compared with only 7.7% among non-Hispanic Whites (risk ratio = 1.66, 95% confidence interval: 1.59-1.72; p<.0001). One thousand one hundred and eighty four (1,184) non-Hispanic Black, singleton preterm births and preterm fetal deaths would have been avoided in 2003 had their preterm birth rate been the same as Michigan non-Hispanic Whites. Economic costs associated with these excess Black preterm births and preterm fetal deaths amounted to $329 million (range: $148 million-$598 million) across their lifespan over and above the costs if they were born at term, including costs associated with the initial hospitalization, productivity loss due to perinatal death, and major developmental disabilities. Hence, racial disparity in preterm birth and preterm fetal death has substantial cost implications for society. Improving pregnancy outcomes for African American women and reducing the disparity between Blacks and Whites should continue to be a focus of future research and interventions.

Malpractice burden, rural location, and discontinuation of obstetric care: a study of obstetric providers in Michigan.

CONTEXT: It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. PURPOSE: This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship. METHODS: Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care. FINDINGS: After adjusting for other factors that might influence a physician's decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians' likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly 4-fold higher likelihood of withdrawing obstetric care when compared with urban family physicians. CONCLUSIONS: The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care.

The impact of malpractice burden on Michigan obstetrician-gynecologists' career satisfaction.

BACKGROUND: Medical services for pregnancy and childbirth are inherently risky and unpredictable. In many states, obstetrician-gynecologists (OB-GYNS) who attend the majority of childbirths in the United States and provide the most clinically complex obstetric procedures are struggling with increasing malpractice insurance premiums and litigation risk. Despite its significant implications for patient care, the potential impact of malpractice burden on OB-GYN physicians' career satisfaction has not been rigorously tested in previous research. METHODS: Drawing on data from a statewide survey of obstetric providers in Michigan, this paper examined the association between medical liability burden and OB-GYNs' career satisfaction. Malpractice insurance premiums and malpractice claims experience were used as 2 objective measures for medical liability burden. Descriptive statistics were calculated and multivariable logistic regressions estimated for data analysis. RESULTS: Although most respondents reported satisfaction with their overall career in medicine, 43.7% had become less satisfied over the last 5 years and 34.0% would not recommend obstetrics/gynecology to students seeking career advice. Multivariable regression analysis showed that compared to coverage through an employer, paying > or =$50,000/year for liability insurance premium was associated with lower career satisfaction among OB-GYNs (odds ratio, 0.35; 95% confidence interval, 0.13-0.93). We found no significant impact of malpractice claims experience, including both recent malpractice claims (during the last 5 years [2001--2006]) and earlier malpractice claims (>5 years ago), on overall career satisfaction. CONCLUSIONS: The findings of this study suggest that high malpractice premiums negatively affect OB-GYN physicians' career satisfaction. The impact of the current medical liability climate on quality of care for pregnant women warrants further investigation.

Malpractice liability burden in midwifery: a survey of Michigan certified nurse-midwives.

A statewide survey was conducted among 282 nurse-midwives in Michigan to examine the extent of their current medical liability burden. Two hundred ten responses were received for an adjusted response rate of 76.9%. Data from 145 certified nurse-midwives (CNMs) who were currently engaged in clinical practice in Michigan were used for this analysis. Sixty-nine percent of CNMs reported that liability concerns had a negative impact on their clinical decision making. Most CNMs (88.1%) acquired malpractice insurance coverage through an employer, whereas 4.9% were practicing "bare" due to difficulty in obtaining coverage. Thirty-five percent of the respondents had been named in a malpractice claim at least once in their career, and 15.5% had at least one malpractice payment of $30,000 or more made on their behalf. CNMs who purchased malpractice insurance coverage themselves or were going bare were significantly less likely to include obstetrics in their practice than their counterparts covered through an employer (70.6% versus 87.2%; P = .04). These findings among Michigan CNMs call for further investigation into the consequences of the current malpractice situation surrounding nurse-midwifery practice and its influence on obstetric care, particularly among women from disadvantaged populations.

The effects of medical liability on obstetric care supply in Michigan.

OBJECTIVE: The objective of the study was to examine Michigan obstetric providers' provision of obstetric care and the impact of malpractice concerns on their practice decisions. STUDY DESIGN: Data were obtained from 899 Michigan obstetrician-gynecologists, family physicians, and nurse-midwives via a statewide survey. Statistical tests were conducted to examine differences in obstetric care provision and the influence of various factors across specialties. RESULTS: Among providers currently practicing obstetrics, 18.3%, 18.7%, and 11.9% of obstetrician-gynecologists, family physicians, and nurse-midwives, respectively, planned to discontinue delivering babies in the next 5 years, and 35.5%, 24.5%, and 12.6%, respectively, planned to reduce their provision of high-risk obstetric care. "Risk of malpractice litigation" was 1 of the most cited factors affecting providers' decision to include obstetrics in their practice. CONCLUSION: Litigation risk appears to be an important factor influencing Michigan obstetric providers' decisions about provision of care. Its implications for obstetric care supply and patients' access to care warrants further research.