Sunday, June 04, 2006

Malpractice Insurance

The scientific literature shows that homebirth is not as safe as hospital birth. Evidently, actuarial insurance data shows the same thing.

The malpractice insurance industry is based entirely on statistics about risk. As risk rises, malpractice insurance premiums rise. Obstetricians pay particularly high malpractice premiums because there are many lawsuits agains obstetricians, and many large financial payouts. In other words, the risk of having an adverse event occur followed by a lawsuit followed by a high payout is higher in obstetrics than many other medical specialties.

Malpractice insurance companies have no philosophical ax to grind. They are hardly friends of physicians. Their entire business is based on calculating risk and pricing malpractice insurance accordingly. Many malpractice insurance companies will void a doctor's malpractice insurance if she participates in a homebirth. Many malpractice insurance companies refuse to write policies for homebirth midwives, or price their policies at exhorbitant rates. Malpractice insurance companies clearly believe that the scientific evidence shows that the risk of homebirth is higher than hospital birth.

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23 Old Comments:

Insurance companies calculate the risk of a lawsuit within a certain specialty - NOT risk of an adverse event.

By Anonymous Anonymous, at 10:05 PM  

It's interesting that everytime I've purchased a policy for out-of-hospital birth I've never heard the agent quote science as the basis for the high premium. The reason I get is there aren't enough of us to sustain a lower rate and we don't get sued enough so they've got to make the money for the potential pay-off somewhere. I wonder why I'm not getting the same line as the doctor?

It's like the insurance companies that won't pay for a HOME BIRTH as facility because it's "not as safe" as a hospital facility but will pay for a BIRTH AT HOME as event. Silly science.

By Anonymous Clever ID, at 11:36 PM  

with-in a field OBs actually skew the stats on birth providers-- ask the CNMs you are around.
Also there are malpractice companies who are owned and run by physicians -- big surprise there.

By Anonymous Anonymous, at 12:10 AM  

It seems like a lot of posts are being deleted lately. Amy, we are being accused of not presenting decient arguements, but then select posts are deleted without explination. Posts without personal attacks, objectionable language, or offensive content.

What's up?

By Anonymous Anonymous, at 12:38 AM  

I have only deleted 3 posts, 2 from one person (anonymous) that were inappropriate and 1 responding to an inappropriate post. I have deleted no others.

By Blogger Amy Tuteur, MD, at 6:52 AM  

I live in a state (Oklahoma) where malpractice insurers have withdrawn coverage for OB's covering VBAC's. As of 14 months ago, there was one hospital in the state that would allow vbac's due to this insurance issue. I know, because I had a child at that time, and I had to have it in this hospital due to these issues. What do you think of this?

Following your thinking, that would indicate that malpractice companies believe that a TOL in a vbac is too high of a risk to cover. I'm curious as to your opinion on this issue. Thanks!

By Anonymous OKAnonymous, at 9:11 PM  

"Following your thinking, that would indicate that malpractice companies believe that a TOL in a vbac is too high of a risk to cover."

That's right. Unfortunately, the insurance companies think it will cost them less if women who have had a previous C-section automatically have a repeat C-section.

It will be interesting to see what actually happens. Will there be fewer large payouts, or will we see an increase in lawsuits and payouts for women who have C-section complications and argue that they didn't need a repeat C-section to begin with?

By Blogger Amy Tuteur, MD, at 9:30 PM  

I am a homebirth midwife who lost my physician supervision. This happened after a conversation between the MD and the malpractice provider. The MD was told that if she had a relationship with a homebirth midwife, they would cancel the insurance for the entire practice.

The insurance company's reason for refusing to cover homebirth midwifery had nothing to do with birth statistics. They felt that since ACOG is on record saying that homebirth midwives offer "sub-standard care" that the malpractice provider would be at increase risk of having that used against them in a court case.

This shows the circular arguement: ACOG says it is more dangerous so insurers won't give coverage. Insurers won't give coverage so it must be more dangerous.

By Anonymous Anonymous, at 2:04 AM  

"The insurance company's reason for refusing to cover homebirth midwifery had nothing to do with birth statistics. They felt that since ACOG is on record saying that homebirth midwives offer "sub-standard care" that the malpractice provider would be at increase risk of having that used against them in a court case."

Yes, but ACOG says that because there is no evidence that homebirth is as safe as hospital birth. So no matter what ACOG says, a plaintiff's lawyer can refer to the existing studies; the midwife and the doctor who covered her will lose the case and the insurance company will lose their money.

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