Cultures of Claiming: Local Variation in Malpractice Claim Frequency

Abstract

While several studies have examined rates of malpractice claims at state levels, there is little systematic work looking at variations of claiming rates within a state. This study reports on small area variations in malpractice claims rates within New York State over a 14 year period. Counties with high rates generally had high rates over the entire period, while counties with low rates maintained low rates. Rates across counties varied considerably, with an almost 5 times difference between the rates for the lowest county and the highest county. In a multivariate analysis of potential factors influencing a county's rate, median family income was one of the strongest factors positively associated with the claims rate. A measure of the risk of hospital admissions for an adverse outcome also had a strong association with the county's malpractice claims rate, but the risk factor was negatively associated with high claims rates, perhaps suggesting an association with quality of care and malpractice claims. The number of lawyers per capita was weakly, but positively, associated with the claims rate.