Evaluating the impact of 2011 tort reform limiting noneconomic damages in North Carolina and Tennessee on testing, imaging, and procedure utilization
研究2011年北卡和田纳西州限制非经济损失的侵权改革对Medicare按服务收费人群的检查、影像和手术使用率及调整后人均成本的影响，发现除田纳西州手术成本小幅增加外，无显著经济影响。
OBJECTIVE: To evaluate the impact of tort reform laws passed in 2011 capping noneconomic damages in North Carolina and Tennessee on rates and adjusted per user costs of tests, imaging, and procedures in the Medicare fee-for-service population. STUDY SETTING AND DESIGN: State-level synthetic difference-in-differences, adjusting for the percent of FFS Medicare beneficiaries in the state who were female, had ever been on Medicare Advantage, were eligible for Medicaid for at least 1 month of the year, and total state risk-adjusted, standardized per-capita costs. Analyses of North Carolina and Tennessee were performed separately. We measured the average treatment effect on the treated. DATA SOURCES AND ANALYTIC SAMPLE: Centers for Medicare and Medicaid Services Geographic Variation Public Use File, 2007-2019. PRINCIPAL FINDINGS: Our analysis showed no economically significant impact of these laws in either state, though we found a small but statistically significant increase (average treatment effect on the treated: $46, 95% confidence interval: $6-$87) in adjusted per user cost of procedures in Tennessee. CONCLUSIONS: Our findings suggest that caps on noneconomic damages alone may be insufficient to modify physician practice habits and impact utilization. Future work should attempt to better understand the economic and noneconomic incentives that shape physician ordering decisions.