08844nam 2200661 a 450 991082835170332120240417000109.00-309-18595-51-280-21469-497866102146930-309-54300-20-585-17751-1(CKB)110986584750856(OCoLC)726823034(CaPaEBR)ebrary10062988(SSID)ssj0000200554(PQKBManifestationID)12024988(PQKBTitleCode)TC0000200554(PQKBWorkID)10220767(PQKB)11719327(Au-PeEL)EBL3377033(CaPaEBR)ebr10062988(OCoLC)923267717(MiAaPQ)EBC3377033(EXLCZ)9911098658475085619890607d1989 uy 0engurcn|||||||||txtccrMedical professional liability and the delivery of obstetrical careVol. 1 /Victoria P. Rostow and Roger J. Bulger, editors ; Committee to Study Medical Professional Liability and the Delivery of Obstetrical Care, Division of Health Promotion and Disease Prevention, Institute of Medicine1st ed.Washington, D.C. National Academy Press19891 online resource (255 p.) Medical professional liability and the delivery of obstetrical careBibliographic Level Mode of Issuance: Monograph0-309-03982-7 Includes bibliographical references and index.Medical Professional Liability and the Delivery of Obstetrical Care -- Copyright -- Chairman's Preface -- Contents -- 1 Summary of Conclusions and Recommendations -- MEDICAL PROFESSIONAL LIABILITY CONTROVERSY -- PROBLEM MOST ACUTE IN OBSTETRICS -- LIABILITY'S BROADER SCOPE -- ETHICAL CONSIDERATIONS -- STUDY FOCUS AND FINDINGS -- Maternity Care in the United States -- Availability of Obstetrical Providers -- Obstetrical Care for Poor Women and Women Served by Medicaid -- Practice of Obstetrics -- Obstetrical Malpractice Insurance -- The Tort System and Its Alternatives -- THE COMMITTEE'S RECOMMENDATIONS -- Long-Term Recommendations -- Short-Term Solutions -- 2 Maternity Care in the United States -- OBSTETRICAL PRACTITIONERS -- Obstetrician-Gynecologists -- Family and General Practitioners -- Certified Nurse-Midwives -- Other Practitioners -- FACILITIES OFFERING PRENATAL CARE -- Hospitals -- Local and State Health Departments -- Community and Migrant Health Centers -- LABOR AND DELIVERY SERVICES -- FINANCING OF MATERNITY CARE -- NEED FOR OBSTETRICAL CARE -- Evidence of Existing Shortages of Obstetrical Services -- Insufficient Prenatal Care -- Arrested Decline in Infant Mortality -- Inability to Pay for Care -- Physician Shortage in Rural Areas -- Projected Increase in Need for Obstetrical Services -- REFERENCES -- 3 The Effects of Medical Professional Liability on the Availability of Obstetrical Providers -- OBSTETRICIAN-GYNECOLOGISTS -- Careers in Obstetrics -- Concerns About Professional Liability -- Response to Concerns About Liability -- Elimination of Obstetrical Practice -- Reduced Volume of Obstetrical Care -- Reduced Care of High-Risk Women -- Trends -- FAMILY PHYSICIANS -- Malpractice Insurance Costs -- Other Economic Factors -- Concerns About Professional Liability -- Response to Insurance and Liability Concerns.Elimination of Obstetrical Practice -- Adverse Effects on Rural Areas -- NURSE-MIDWIVES -- Availability and Costs of Professional Liability Insurance -- Response to Insurance Problems -- Changes in Practice Setting -- Changes in Techniques of Practice -- REFERENCES -- 4 The Impact of Medical Professional Liability on the Provision of Obstetrical Care to Poor Women and Women Served… -- PROFESSIONAL LIABILITY AND OBSTETRICAL CARE UNDER MEDICAID -- BACKGROUND: THE ROLE OF MEDICAID IN THE DELIVERY OF OBSTETRICAL CARE -- Physician Participation in Medicaid -- Reduced Obstetrical Care for the Poor -- High Insurance Premiums, Low Reimbursement Rates -- Fear of Suit -- Professional Liability Concerns and the Reduction of Care -- PROFESSIONAL LIABILITY AND OBSTETRICAL CARE IN COMMUNITY AND MIGRANT HEALTH CENTERS -- Problems Recruiting Providers -- Problems with Access -- Reduced Quality of Care and Increased Risk of Suit -- Prohibitive Insurance Costs -- CONCLUSION -- REFERENCES -- 5 The Effects of Medical Professional Liability on the Practice of Obstetrics -- CHANGES IN PRACTICE PATTERNS OF INDIVIDUAL PHYSICIANS -- THE RISING CESAREAN SECTION RATE -- Electronic Fetal Monitoring -- History -- Regulatory Failure -- Results of Randomized Clinical Trials -- Effect of EFM on the Frequency of Cerebral Palsy -- Electronic Fetal Monitoring, Cerebral Palsy, and Medical Malpractice -- Conclusion -- PRACTICE PATTERNS IN DEPARTMENTS OF OBSTETRICS -- Reported Changes in Practice -- Implications for Training -- Effects on Careers in Obstetrics -- Effects on Access to Care -- IMPACT OF MEDICAL PROFESSIONAL LIABILITY ON THE PHYSICIAN-PATIENT RELATIONSHIP -- The Importance of Trust -- Consequences of the Breakdown in Trust -- REFERENCES -- 6 Obstetrical Malpractice Insurance -- THE STRUCTURE OF THE MARKET -- Limits of Coverage.Availability of Medical Malpractice Insurance -- Physicians -- Nurse-Midwives -- THE AFFORDABILITY OF PREMIUMS -- Premiums as a Percentage of Gross Income -- Premiums as a Percentage of Professional Expenses -- Premiums as a Percentage of Net Income -- Rising Professional Liability Premiums Linked to Increases in Fees -- PROFITABILITY OF MEDICAL MALPRACTICE INSURANCE -- Insurer Risk Management Activity -- Data Gathering and Analysis -- Clinical Standard Setting and Protocol Development -- Educational Efforts -- Discounted Premiums as Risk Management Incentives -- PROPOSALS TO ALTER THE MEDICAL MALPRACTICE INSURANCE SYSTEM -- Spreading the Costs of Coverage Over a Wider Base -- Limiting the Number of Claims -- Limiting the Amount of Awards -- Experience Rating of Physicians for Medical Malpractice -- CONCLUSION -- REFERENCES -- 7 The Legal System: The Committee's Findings and Proposals for Change -- THE TORT SYSTEM -- Tort Reforms: The Committee's Findings -- TORT REFORM: THE COMMITTEE'S RECOMMENDATIONS -- ALTERNATIVES TO THE TORT SYSTEM -- No-Fault Compensation for Certain Events -- Virginia's Compensation System for Birth-Related Injuries: A Case Study of DCE -- The AMA-Specialty Society Medical Liability Project -- Claims Resolution Function -- Credentialing and Disciplinary Functions -- Codification of the Legal Elements of Medical Liability -- Private Contracts -- Economic Damage Guarantee (Moore-Gephardt Proposal) -- Social Insurance -- OTHER NEEDED REFORMS -- Expansion of the National Health Service Corps -- Extension of the Federal Tort Claims Act Coverage -- Liability Coverage for Physicians Providing Public Health Services -- REFERENCES -- 8 Principal Findings and Recommendations -- PRINCIPAL FINDINGS -- Medical Malpractice Insurance Trends and Their Implications -- Effects of Professional Liability Concerns on Access to Care.Effects of Professional Liability Concerns on the Practice of Obstetrics -- Effects of Professional Liability Concerns on the Physician-Patient Relationship -- RECOMMENDATIONS -- Long-Term Recommendations -- Short-Term Solutions -- Glossary -- Bibliography -- CASES, REGULATIONS, AND STATUTES -- Appendixes -- Appendix A Summary of Methodology Used in Studies of Changes in Obstetrical Practice -- Survey Population -- Samples -- Response Rates -- Phraseology -- Appendix B Summary of Study Results Regarding Changes in Obstetrical Practice -- Appendix C Summary of Study Results Regarding Professional Liability, Family Practitioners, and Rural Areas -- Appendix D State and National Liability Surveys Summarized -- State Studies -- National Studies -- Appendix E Survey of Selected Risk Management Activities -- Appendix F Risk Management Activities and Experience Rating Policies of Selected Malpractice Insurers -- Appendix G Possible Modifications to the Virginia Neurological Birth-Related Injury Compensation Act -- Members of the Committee -- Index.ObstetriciansMalpracticeUnited StatesPhysicians' malpractice insuranceUnited StatesObstetriciansMalpracticePhysicians' malpractice insurance346.7303/32347.306332Rostow Victoria P1626328Bulger Roger J.1933-1093934MiAaPQMiAaPQMiAaPQBOOK9910828351703321Medical professional liability and the delivery of obstetrical care3962282UNINA